4. 3. Era of short course chemotherapy
Chemotherapy of TB has undergone revolutionary changes
in the seventies owing to the availability of two well tolerated oral
bactericidal drugs rifampicin and pyrazinamide. Short Course Chemotherapy
(SCC) implies a new rationale of chemotherapy and not merely administering
formally accepted regimens for short periods. By using these regimens
it has now not only become possible to simplify treatment and reduce its
duration, but it is also possible to improve the efficacy of treatment.
Discovery of rifampicin in 1967 is considered as one of the greatest achievements
in the history of development of anti-TB drugs. After its discovery no
new drug has been found nor is in the offing. However, one should not
forget that INH is still the queen of all drugs and if we wish to have
a new drug(s) it should be comparable with INH. In the words of Dr Wallace
Fox : INH, the wonder drug of 1950s is (and is likely to remain)
the standard drug to be given for the full duration of all SCC regimens
because of its efficacy and high early bactericidal activity, its small
bulk and low toxicity. However, laboratory evidence suggests that the
sterilizing role of INH is less than those of rifampicin and pyrazinamide.
In planning short course regimens the choice the physician faces is what
drugs should be added to INH97. Dr Fox is considered as the father
of clinical trials for chemotherapy of TB.
Dr. Wallace Fox, Director BMRC, UK
Father of Chemotherapy