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Biomedical subjects

D E Snider

Publications and source records attributed to D E Snider.

At least 91 records · Page 5Linked to original sources
PubMed1983

Hepatotoxicity from isoniazid and rifampin among children treated for tuberculosis.

To estimate rates of hepatotoxicity in the United States among children treated for tuberculosis, we conducted a retrospective survey of health departments and individual practitioners. We received 874 reports suitable for analysis of children treated during 1977 to 1979. A total of 16 hepatotoxic reactions were reported; 14/430 (3.3%) children receiving isoniazid and rifampin had a hepatotoxic reaction, which approximates the rate seen in adults taking these drugs. Half of the reactions occurred during the first month of therapy, and all of the well-documented reactions were noted during the first 10 weeks. Because the likelihood of hepatotoxicity may be increased with higher drug doses, limiting the dose of isoniazid to 10 mg/kg and that of rifampin to 15 mg/kg may help minimize hepatotoxic reactions. Because more serious disease, especially disseminated tuberculosis, may further increase the risk of hepatotoxicity, close monitoring of such children receiving isoniazid and rifampin should help minimize serious hepatotoxicity. Routine biochemical monitoring may not be necessary for all children, eg, those with mild forms of disease and those with normal pretreatment liver function who are treated with lower drug doses.

Adolescent↗
PubMed1982

Successful intermittent treatment of smear-positive pulmonary tuberculosis in six months: a cooperative study in Poland.

One hundred nineteen patients 15 to 70 yr of age, all with smear-positive, previously untreated, pulmonary tuberculosis, were treated with a 6-month regimen containing isoniazid and rifampin, supplemented during the initial 2 months with streptomycin and pyrazinamide. The 4 drugs were administered daily in the hospital during the initial 2 months, followed by isoniazid and rifampin administered twice weekly on an outpatient basis during the next 4 months. Adverse reactions to the drugs were seen in 19 patients, but only 6 had toxic reactions requiring withdrawal of drugs for 7 days or more. Three of the toxic reactions were attributed to streptomycin, 2 to rifampin, 1 to isoniazid, and none to pyrazinamide. Eighty-five (71%) of the 119 eligible patients completed treatment. After the first 2 months of therapy, 91% of these patients had negative sputum cultures, and all of them had negative cultures by the end of the third month of treatment. No relapses have occurred among the 84 patients observed for 18 months after therapy was completed.

Adolescent↗
PubMed1982

An attempt to eradicate silicotuberculosis in Ottawa County, Oklahoma.

In 1974 and 1975, a selective tuberculosis screening program was conducted in a small mining community in Ottawa County, Oklahoma. Former miners, 50 years of age and over, who had abnormal chest radiographs consistent with silicosis or inactive tuberculosis and positive tuberculin skin tests, were offered isoniazid preventive therapy. Since the project ended, morbidity from silicotuberculosis has declined but silicotuberculosis has continued to occur. In this report, we examine the reasons for the failure to eradicate this disease from the community.

Humans↗
PubMed1981

Transmission of multiple drug-resistant tuberculosis: report of a school and community outbreak.

An outbreak of tuberculosis in 1976 was caused by mycobacteria resistant to isoniazid (INH), streptomycin (SM), and para-aminosalicylic acid (PAS). High rates of infection associated with exposure to the index case suggested that transmission of resistant organisms had occurred, and the subsequent appearance of bacteriologically proven INH-SM-PAS-resistant tuberculosis in four school contacts of the index case confirmed this fact. Retrospective investigation revealed that the school outbreak was part of an ongoing community outbreak dating back at least to 1964. Through the use of case histories, drug-susceptibility patterns, and phage typing, 15 documented and seven presumed INH-SM-PAS-resistant, epidemiologically linked cases were found; two of these persons died of tuberculosis. Six additional cases with INH-SM-PAS resistance that could not be epidemiologically linked to the outbreak were also identified. The potential of drug-resistant strains for causing disease in humans should not underestimated.

Adolescent↗
PubMed1981

Rapid drug-susceptibility testing of Mycobacterium tuberculosis.

Three methods for rapidly determining the susceptibility of Mycobacterium Tuberculosis isolates to isoniazid, rifampin, ethambutol, streptomycin, and para-aminosalicylic acid were evaluated in a large-scale, blind study. Two of the methods measured evolution of CO2 from radio-labeled substrate (14CO2), and one method measured incorporation of 3H-uracil into ribonucleic acid. Rapid indirect drug-susceptibility test results for nearly 300 isolates were compared with those obtained using a standard modified proportion technique. The 3H-uracil uptake method proved to be unacceptable. Over-all, the results obtained using the 14CO2 methods and the standard method were similar. In general, there was greater agreement between the 14CO2 and proportion techniques with drug-susceptible strains than with drug-resistant strains. Among drug-resistant strains, both 14CO2 methods were more reliable for determining resistance to rifampin than to other drugs. This study demonstrates that large-scale, blind evaluations of new laboratory procedures are valuable. Our results indicate that methods relying o the enzymatic release of 14CO2 should be further refined and evaluated.

Aminosalicylic Acid↗
PubMed1981

Short-course (6-month) cooperative tuberculosis study in Poland: results 30 months after completion of treatment.

This final report compared the efficacy of four 6-month chemotherapy regimens 30 months after the completion of treatment. All patients received isoniazid, rifampin, and ethambutol daily in hospital for the first 8 wk of treatment. One group continued to receive these 3 drugs daily as outpatients for an additional 18 wk; a second group received the same drugs twice-weekly, and a third group received the 3 drugs once-weekly during the 18-wk "continuation phase." A fourth group of patients received 2 drugs, isoniazid and rifampin, twice-weekly during the continuation phase. Drug toxicity was not a major problem; drugs were permanently discontinued in only 1% of the patients. All 4 regimens were highly effective in achieving sputum negativity. However, the relapse rate was found to be relatively high for all regimens (range, 8 to 22%).

Adolescent↗
PubMed1980

Pyridoxine supplementation during isoniazid therapy.

Vitamin B6 (pyridoxine) supplementation during isoniazid (INH) therapy is necessary in some patients to prevent the development of peripheral neuropathy. In vivo pyridoxine is converted into coenzymes which play an essential role in the metabolism of protein, carbohydrates, fatty acids, and several other substances, including brain amines, INH apparently competitively inhibits the action of pyridoxine in these metabolic functions. The reported frequency of INH-induced neuropathy in various studies is reviewed and population groups at relatively high risk of developing this complication are identified. The routine use of pyridoxine supplementation to prevent peripheral neuropathy in high risk populations is recommended.

Humans↗
PubMed1980

The incidence of cancer among participants in controlled, randomized isoniazid preventive therapy trial.

Cancer morbidity and mortality were examined among 11,894 Puerto Rican participants in a US Public Health Service preventive therapy trial begun in 1957. The mean duration of follow-up was 18 years (range 16-19 years). No statistically significant difference in overall cancer rates was observed between the participants in the trial assigned isoniazid and those assigned placebo. There were also no significant differences between the groups when rates for specific types of cancer and age-specific cancer rates were compared. No trend toward an increasing cancer rate in the isoniazid group was observed with the passage of time. The mortality rate due to cancer was similar in the two groups. These data coupled with other information reported in the literature provide substantial evidence that isoniazid, when given in the usual therapeutic doses, is not carcinogenic in humans.

Adolescent↗
PubMed1980

Drug resistance among previously treated tuberculosis patients, a brief report.

The choice of an appropriate chemotherapeutic regimen for the treatment of tuberculosis is more difficult if the patient has been treated for tuberculosis in the past. This study was undertaken to determine drug-resistance rates among patients previously treated with isoniazid (INH), streptomycin (SM), and/or paraaminosalicylic acid (PAS). The study population consisted of 4,017 patients for whom the length and type of previous therapy was known. Forty-one per cent of these patients were found to be excreting organisms resistant to 1 or more of the following 3 drugs: INH, SM, and PAS. Resistance to INH was encountered most (36.8%), followed by resistance to SM (19.2%), and resistance to PAS (17.2%). Resistance rates were considerably higher among the 1,168 patients who had previously received monotherapy (60%) than among those who had never received single-drug therapy (33%). In general, the percentage of patients excreting resistant organisms increased with increasing duration of the previous therapy. The implications of these findings for the design of retreatment regimens are discussed.

Aminosalicylic Acid↗