[Tuberculosis therapy in patients with renal insufficiency, dialysis and following kidney transplantation].
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Biomedical subjects
Publications and source records attributed to R Urbanczik.
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46 strains of Mycobacterium tuberculosis were studied as to their susceptibility to isoniazid (INH) or to INH + prothionamide (PTH) in the presence or absence of dapsone (DDS) by microdilution transfer plate technique. Synergy with DDS as defined by Berenbaum in 1978 was seen in 78% with INH and in 91% with INH + PTH. It concerned the minimal inhibitory concentration, whereas the minimal bactericidal concentration (MBC) was unaffected in the case of INH and it was increased in only 52% with INH + PTH. The latter MBC proportion mentioned would be decreased to roughly 16% accepting an only twofold decrease in the MBC as possibly due to dilution errors. The possible effect of dimethyl sulphoxide on the reported results is discussed.
The slow integration of antituberculosis programmes into general health service activities is the most important problem encountered. Short course regimes with high cost drugs require the supervision which, for the time being, is difficult to realize on a large scale except, perhaps, in big cities. Though pilot studies of short course regimes are welcomed, for the immediate use in both the capitals and the rural areas mainly self-administered low-cost systems may be considered for the chemotherapy of tuberculosis, with basic division of patients into groups of previously untreated and previously treated persons (which would affect the drug combination used), and smear (and culture?) positive or negative persons (which might affect the duration of therapy administered). For the latter, it is of considerable importance to continue improving the network of bacteriological laboratories.
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Increased antimycobacterial activity of Isoprodian (isoniazid + prothionamide + dapsone) may be due to (i) decreased mutation rate for INH resistance provoked in mycobacteria by DDS (in 2 of 3 strains tested); (ii) leakage of K+, Na+ or Ca++ caused by INH and/or by PTH (in all 3 strains tested), and (iii) indicating damages which may increase the low level penetration of DDS into the cell in sub-MIC concentrations as shown by phage proliferation changes (tested in 1 strain with 1 phage).
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