rifampin and Pneumoconiosis

This is the first prospective clinical trial recorded to date of short-course chemotherapy in pulmonary tuberculosis complicated by pneumoconiosis. Forty-eight anthrasillicotic and 11 silicotic patients with previously untreated pulmonary tuberculosis completed 9-month, short-course chemotherapy regimens: 2 months of daily streptomycin, isoniazid, rifampicin, and pyrazinamide followed by daily isoniazid and rifampicin for 7 months (2SHRZ/7HR). There were 3 treatment failures (5%). The remaining 56 patients (95%) all had their sputum converted within 4 months (mean, 1.5 months). Bacteriologic relapses were noted in 3 patients (5%) after 18 to 40 months of follow-up (mean, 28.4 months). The relapses occurred within 7 months after chemotherapy was stopped. There were 2 deaths from nontuberculosis causes during the follow-up period. Fifty-one patients (90%) remained bacteriologically sterile for 28.4 +/- 6.1 months. These results suggest that the 2SHRZ/7HR regimen is satisfactory in treating anthrasilicotic or silicotic patients with pulmonary tuberculosis, though antituberculosis chemotherapy seemed less effective in patients with pneumoconiosis than in those without pneumoconiosis.

Topics: Adult; Aged; Antitubercular Agents; Clinical Trials as Topic; Drug Therapy, Combination; Humans; Isoniazid; Middle Aged; Pneumoconiosis; Prospective Studies; Pyrazinamide; Recurrence; Rifampin; Streptomycin; Time Factors; Tuberculosis, Pulmonary

To assess the relationship between mixed dust fibrosis (MDF) and tuberculosis.. We performed a comparative analysis with MDF, silicosis, and macular pneumoconiosis (Mac), using autopsy records from 1975 to 1994.. Prevalences of having tuberculosis among MDF, silicosis, and Mac were not significantly different, albeit a tendency of higher prevalence in silicosis. Cure rates of tuberculosis were, in order, silicosis < MDF < Mac (P=0. 085). Death rates associated with tuberculosis were, in order, silicosis > MDF=Mac (P=0.911). With respect to the two types of association with tuberculosis, i.e., combined type (tuberculopneumoconiosis) and complicated one (pneumoconiosis with tuberculosis); the former was significantly dominant in silicosis, the latter was significantly dominant in Mac, and intermediate in MDF. As a whole, the complicated type had a tendency of a higher cure rate than the combined type (P=0.071). Although the differences of profiles between the combined and complicated types were not statistically significant, the combined type had a tendency to have longer duration of exposure to dusts, earlier registration for treatment, higher profusion score, and earlier death compared with the complicated type.. From our findings, MDF takes an intermediate position between silicosis and Mac regarding the relationship with tuberculosis. The type of association with tuberculosis rather than the kind of background pneumoconiosis seemed to be more important in light of responsiveness to the treatment.

Topics: Autopsy; Dust; Female; Humans; Japan; Male; Mining; Occupational Exposure; Pneumoconiosis; Pulmonary Fibrosis; Rifampin; Silicon Dioxide; Silicosis; Tuberculosis, Pulmonary

The outcomes of 20 anthracite miners with coal workers' pneumoconiosis and culture-proved pulmonary tuberculosis treated with rifampin-containing chemotherapeutic regimens were determined by a retrospective review. Their mean age was 65 yr, and the duration of underground dust exposure averaged 27 yr. Nine miners had simple pneumoconiosis, 11 had progressive massive fibrosis, and 13 had cavitary disease; 3 also had extrapulmonary disease. All patients were given rifampin (mean, 12 months in survivors) plus one or more other effective agents; the mean duration of treatment with 2 or more drugs was 17 months. Follow-up averaged 46 months in those surviving more than 1 yr. Sputum cultures became negative and remained so within 3 months in 17 patients and within 5 months in the remainder. Eighteen patients survived more than 1 yr after completing chemotherapy. No clinical, radiologic, or bacteriologic relapses were observed during follow-up, but 5 patients died of nontuberculous causes. These results are superior to those reported previously in patients with coal workers' pneumoconiosis treated for pulmonary tuberculosis with regimens not containing rifampin. They suggest that treatment of tuberculosis in coal workers, even in the presence of progressive massive fibrosis and cavitary disease, can yield results as favorable as in nonpneumoconiotic patients provided the initial treatment regimen includes rifampin plus one or more other effective agents.

Topics: Adult; Aged; Coal Mining; Drug Therapy, Combination; Humans; Middle Aged; Pneumoconiosis; Retrospective Studies; Rifampin; Tuberculosis, Pulmonary

Results of a retrospective study of rifampin-combined chemotherapy in 59 coal miners with pneumoconio-tuberculosis are reported. In 43 patients pneumoconiosis had attained the stage of progressive massive fibrosis. The follow-up period ranged from 24 to 78 months, except in 8 patients who died before the twenty-fourth month. Twenty-seven of the 59 patients were treated for the first time, and 32 were in retreatment. In none of them had rifampin been administered before. Although the objective was to administer rifampin in combination with one, 2, or even 3 companion drugs that had not been administered before and that had proved to be active on the patients' bacilli in vitro, this goal was fully reached only in the first treatment group; in 8 of the 32 retreated patients the drugs combined with rifampin were considered ineffective. The speed and rate of bacteriologic conversion were most impressive. Sputum conversion was obtained in 90 per cent of the patients; in the initial treatment group 100 per cent of the patients converted their sputum on culture at 5 months and in the retreatment group the corresponding figure was 84.4 per cent. These bacteriologic results are nearly as favorable as those obtained in cases of advanced pulmonary tuberculosis without pneumoconiosis treated with the same rifampin-containing drug regimens. It was concluded that rifampin-combined chemotherapy largely eliminates the handicap caused by the coexistence of tuberculosis and pneumoconiosis. Side effects due to rifampin were without practical significance. In 3 patients of 57 treated with ethambutol, visual impairment was observed. Mortality was high (27 per cent) but was caused by nontuberculous diseases, especially cardiorespiratory insufficiency. In 10 of the 16 patients who died, death occurred after bacteriologic conversion.

Topics: Coal Mining; Drug Therapy, Combination; Ethambutol; Humans; Liver Function Tests; Pneumoconiosis; Radiography; Retrospective Studies; Rifampin; Sputum; Tuberculosis, Pulmonary

Topics: Aged; Aminosalicylic Acids; Antitubercular Agents; Arthritis, Rheumatoid; Bronchitis; Diabetes Complications; Drug Therapy, Combination; England; Female; Humans; Male; Mass Chest X-Ray; Mycobacterium tuberculosis; Nose; Occupations; Pneumoconiosis; Pulmonary Emphysema; Rifampin; Silicotuberculosis; Sputum; Streptomycin; Tuberculosis, Miliary; Tuberculosis, Pulmonary

Topics: Animals; Body Weight; Coal; Dust; Guinea Pigs; Lung; Lung Diseases; Macrophages; Mycobacterium; Mycobacterium Infections; Organ Size; Pneumoconiosis; Pulmonary Fibrosis; Radiography; Rifampin; Silicon Dioxide; Tracheal Diseases

Topics: Adult; Chronic Disease; Drug Combinations; Drug Resistance, Microbial; Ethambutol; Female; Humans; Male; Middle Aged; Pneumoconiosis; Pulmonary Fibrosis; Rifampin; Sputum; Time Factors; Tuberculosis, Pulmonary