A study was made of cases of tuberculosis treated by chemotherapy in Eastern Glasgow between 1963 and 1968 which developed drug-resistant bacilli. The commonest resistance pattern was to the combination of 3 drugs—streptomycin, p-aminosalicylic acid (P.A.S.) and isoniazid in contrast to resistance to streptomycin alone which predominated 12 years ago. In strains from 6 patients no less than 6 drugs had become ineffective.
Experiments with Escherichia coli confirmed that the ‘high mutation rate’ in the presence of streptomycin, which is characteristic of other tuberculostatic drugs also, is attributable to predictable and progressive mutations.
Six examples are given where outbreaks of cross-infection by drug-resistant bacilli can be assumed.
Get full access to this article
View all access options for this article.
References
1.
AranyL. S.LewisW. G. (1950). Superinfection in tuberculosis. Lancet, 1, 421
2.
BarberMaryGarrodL. P. (1963). Emergence of drug-resistant strains in vitro and in vivo. In Antibiotic and Chemotherapy, p. 213Edinburgh: Livingstone
3.
BruceL. G.CuthbertJ.RitchieJ. A. (1957). Drug resistant tubercule bacilli in a community. Scot. med. J. 2, 83
4.
CorpeR. F.BlalockF. A. (1965). Retreatment of drug resistant tuberculosis at Battey State Hospital. Dis. Chest, 48, 305
5.
CroftonJ.MitchisonD. A. (1948). Streptomycin resistance in pulmonary tuberculosis. Brit. med. J., 2, 1009
6.
CruickshankR. (1950). Proceedings of UNICEF conference on streptomycin in childhood tuberculosis. Lancet, 1, 366
7.
CruickshankR. (1960). In Mackie and McCartney'sA handbook of practical bacteriology, 10th edition, p. 410. Edinburgh: Livingstone
8.
CruickshankR.StewartSheila M. (1961). Detection of resistance to streptomycin, P.A.S. and isoniazid in tubercle bacilli. Assocn. of Clin. Pathologists, Broadsheet No. 32
9.
FurtosN. C.DoaneE. A. (1949). Transmission of streptomycin-resistant tubercle bacilli in man. J. Amer. med. Ass., 140, 1274
10.
Glasgow's X-ray Campaign Against Tuberculosis (1958) Glasgow: Glasgow Corporation
11.
GoldsteinA. (1952). Effect of penicillin on streptomycin-dependant variants in Escherichia coli populations. Science, 116, 113
12.
Report of Internat. Union Against Tuberculosis. (1958). Reported inWhat's New, 43, p. 2. Abbot: Queen-borough, Kent
13.
International Tuberculosis Conf. (1961). Proc. Sixteenth Conference, Toronto, Canada
14.
KleinM. (1947). Mechanism for development of resistance to streptomycin and penicillin. J. Bad., 53, 463
15.
Lancet (1950). Annotation.—Present views on tuberculous meningitis. Lancet, 1, 362
16.
LederbergJ.LederbergEsther M. (1952). Replica plating and Indirect selection of bacterial mutants. J. Bad. 63, 399
17.
MiddlebrookG.DressierS. H. (1955). Isoniazid resistance. Lancet, 1, 669
18.
PaineT. F.FinlandM. (1948). Observations on bacteria sensitive to, resistant to, and dependant upon streptomycin. J. Bad., 56, 207
19.
PriceC. W.RandallW. A.ChandlerV. L.ReedyR. J. (1947). Observations on in vivo and in vitro development of bacterial resistance to streptomycin. J. Bad., 53, 481
20.
PyleM. M. (1947). Relative numbers of resistant tubercle bacilli in sputa of patients before and during treatment with streptomycin. Proc. Staff Meet. Mayo Clin., 22, 465
21.
RaleighJ. W. (1961). Drug resistance is increasing. Maryland Med. J., 10, 479
22.
RammelkampC. H.MaxonT. (1942). Resistance of Staphylococcus aureus to the Action of Penicillin. Proc. Soc. Exper. Biol. & Med., 51, 386
23.
SnyderT. L. (1947). Relative errors of bacteriological plate-counting methods. J. Bad., 54, 641
24.
TinneJ. E. (1957). The growing prevalence of drug resistance among tubercle bacilli, and its assessment. Scot. med. J., 2, 245
25.
TinneJ. E. (1964). Recurring microbial mutations and their association with epidemic cycles and evolution. M.D. Thesis, p. 310. University of Edinburgh
26.
VerbistL.GyselenA. (1964). Capreomycin susceptibility of strains resistant to streptomycin and/or viomycin. Amer. Rev. Resp. Dis., 90, 640
