La tuberculose. Durée du traitement

The systematic use of rifampicin (R) and pyrazinamide (Z) in combination with isoniazid (H) and ethambutol (E) has resulted in a dramatic shortening of the duration of chemotherapy for tuberculosis, since the time when H, streptomycin (S) and PAS (P) were given for 18 to 24 months. Short-course chemotherapy of 6-month duration with the four drugs combination, SHRZ or EHRZ, given for a 2-month initial intensive phase followed by a 4-month continuation phase with HR is as effective and acceptable as the standard 9-month chemotherapy with EHR for the treatment of smear-positive pulmonary tuberculosis. The length of chemotherapy can be reduced neither for smear-negative culture-positive nor for smear-negative culture negative pulmonary tuberculosis nor for extra-pulmonary tuberculosis. Isoniazid has been demonstrated to be active as chemoprophylactic drug in a daily dose of 300 mg (5 - 10 mg/kg children for 6-12 months. Chemoprophilaxis with daily isonazid, rifampicin and pyrazinamide for 2 months is likely to be as active as isoniazid prophylaxis for 12 months.