6-month short-course chemotherapy for tuberculous pleural effusion

T. H. Kim, K. A. Kim, C. M. Lim, Do Lee Sang Do Lee, Y. Koh, Sung Kim Woo Sung Kim, Soon Kim Dong Soon Kim, Dong Kim Won Dong Kim

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Abstract

Background: Short-course chemotherapy for 6 months is well established for pulmonary tuberculosis. However, little is known about the efficacy of the short-course chemotherapy for tuberculous pleural effusion. Tuberculous pleural effusion itself may be self-limiting without any treatment, but about two thirds of the patients with tuberculous pleural effusion may subsequently develop pulmonary tuberculosis within 5 years. After completing treatment for tuberculous pleural effusion, prolonged follow-up is necessary for evaluating the efficacy of the treatment. There is still no report on the efficacy of 6- month regimens for tuberculous pleural effusion in Korea, where the incidence of tuberculous disease and drug resistance is high. We studied the efficacy of 6 month short-course chemotherapy comparing with 9 month chemotherapy. Method: Retrospective study was done through medical record review in 238 patients with tuberculous pleural effusion who admitted to Asan Medical Center during May 1989-May 1993. The diagnosis of tuberculous pleural effusion was made by bacteriologic or histopathologic study. Results: Among 238 patients, 38 patients were dropped out during follow-up period. In 2 patients, second line drugs were prescribed according to known drug resistance results. And, in 23 patients, treatment longer than 9 months was done due to accompanying extrapulmonary tuberculosis or drug resistance. In 8 patients, treatment regimen was changed due to hepatotoxicity. Remaining 167 cases (70.2%) completed the treatment as scheduled; 6 month chemotherapy in 88 cases and 9 month chemotherapy in 79 cases. In 60 patients (35.9%) with pleural effusion only in chest X-ray finding, sputum smear or culture for M. tuberculosis was positive in 6 cases (10.0%), and in 63 patients (37.7%) with radiologically inactive pulmonary tuberculosis, sputum smear or culture was positive in 18 cases (28.6%). In 44 patients (26.3%) with radiologically active pulmonary tuberculosis, the sputum smear or culture was positive in 24 cases (54.5%). In 6-month chemotherapy group (n=88), during mean 23 months (range, 1-61 months) follow-up period, pulmonary tuberculosis developed in 1 case (1.4 %). In 9-month chemotherapy group(n = 79), during mean 23 months (range; 3-70 months) follow-up period, pulmonary tuberculosis developed in 2 cases (2.5%). All the cases who developed pulmonary tuberculosis also showed active pulmonary tuberculosis on initial chest X-ray before treatment. Conclusion: In patients with tuberculous pleural effusion, the incidence of pulmonary tuberculosis after 6 month chemotherapy showed no difference from that after 9 month chemotherapy. Thus, 6 month short-course chemotherapy seems to be an effective treatment for tuberculous pleural effusion.

Original languageEnglish
Pages (from-to)509-518
Number of pages10
JournalTuberculosis and Respiratory Diseases
Volume45
Issue number3
DOIs
StatePublished - 1998 Jan 1

Keywords

  • Short-course chemotherapy
  • Tuberculous pleural effusion

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    Kim, T. H., Kim, K. A., Lim, C. M., Sang Do Lee, D. L., Koh, Y., Woo Sung Kim, S. K., Dong Soon Kim, S. K., & Won Dong Kim, D. K. (1998). 6-month short-course chemotherapy for tuberculous pleural effusion. Tuberculosis and Respiratory Diseases, 45(3), 509-518. https://doi.org/10.4046/trd.1998.45.3.509