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July 21, 1962


Author Affiliations

New York City

JAMA. 1962;181(3):252. doi:10.1001/jama.1962.03050290074015

In a recently published communication, Cohen1 calls attention to the disturbing problem of drug-resistant tubercle bacilli. This report and similar ones from widespread areas merit serious consideration but require critical analysis.

The problem of drug-resistant tubercle bacilli may be examined from 2 aspects: (1) from the point of view of the reduction in therapeutic effectiveness of the drugs in an individual patient and (2) in terms of the epidemiological implications of the spread of drug-resistant organisms within a community.

From the therapeutic point of view, there is general agreement that the demonstration of the emergence of streptomycin resistance in vitro correlates closely with the loss of drug effectiveness in the patient. This is probably true, also, for the secondary antituberculous drugs such as aminosalicylic acid, pyrazinamide, cycloserine, viomycin, kanamycin, and ethionamide. There are considerable differences of opinion concerning the clinical significance of isolating isoniazid-resistant strains of tubercle bacilli from