ACTH AND CORTISONE AS ADJUNCTS IN THE TREATMENT OF ADVANCED PULMONARY TUBERCULOSIS

Abstract

Three patients, all chronic alcoholics, with far advanced, active pulmonary tuberculosis, who became moribund while on antituberculosis therapy, were treated with cortisone or hydro-cortisone. Dramatic improvement followed as manifested by blood pressure, temperature, mental alertness, subjective well-being, ability to take oral feeding and to tolerate mobilization. Serial chest X-rays did not change during cortisone treatment in 2, and showed remarkable clearing in one patient. No evidence of spread of tuberculous process. Dosage did not exceed 200 mg of cortisone or 50 units of ACTH in a day (given intravenously, intramuscularly or orally). Duration of therapy was based on stabilization of clinical condition (21-31) days. No "rebound" was seen on gradual reduction and cessation of steroids. Improvement continued in the subsequent observation period. It is pointed out that animal experiments offer no reliable comparison for the clinical situation and that the fear of the use of steroids was mostly based upon experiences with drug-resistant or inadequately treated tuberculosis.