Phenothiazines: an alternative to conventional therapy for the initial management of suspected multidrug resistant tuberculosis. A call for studies

Increased frequency of multidrug resistant strains of Mycobacterium tubercu losis results from inappropriate treatment and lack of patient compliance. The Center for Disease Control/American Thoracic Society (CDC/ATS) guidelin es issued for the management of newly diagnosed cases of tuberculosis (TB) will not be totally effective regardless of adherence to the guidelines and patient cooperation. The long interim period between the diagnosis of TB a nd confirmation of antibiotic susceptibility contributes to the infection r ate. Consequently, the use of an adjuvant that is known to inhibit all enco untered multidrug resistant strains of M. tuberculosis may be helpful until antibiotic susceptibility is known. Phenothiazines such as chlorpromazine, methdilazine and thioridazine are effective against strains of M. tubercul osis in vitro and in vivo. It is recommended that studies be designed and c onducted for the purpose of managing new cases of TB that emanate from area s known to harbour multidrug resistant strains of M. tuberculosis, with phe nothiazines as adjuvants to the regimen recommended by the CDC/ATS guidelin es until antibiotic susceptibility is defined. Because the normal maximum p eriod for obtaining conventional antibiotic susceptibility results is less than 7 or 8 weeks, the probability of serious side effects from the use of a phenothiazine is remote. (C) 2000 Published by Elsevier Science B.V. and International Society of Chemotherapy All rights reserved.