Cavitating pulmonary tuberculosis: a global challenge

Editor – We were concerned that a new treatment for tuberculosis (TB) was being advocated without the benefit of a randomised controlled trial (W Saeed, Clin Med February 2012 pp 40–1). The authors argue that cavitary pulmonary TB relapses following therapy in 21–25% of cases and that additional drugs (levofloxacin and amikacin) are required to prevent this. However, in a treatment trial of sputum smear-positive TB (a sine qua non for cavitary disease) with relatives supervising therapy in the follow-up phase, a standard six-month regimen with an initial phase of four drugs resulted in negative sputum cultures at 30 months in 94%.¹ Furthermore, while levofloxacin has few adverse effects, irreversible hearing loss is a common finding in those treated with amikacin.² Research itself is known to improve patient outcomes. Improved care rather than the addition of two further drugs to the standard treatment regimen for TB may have been responsible for the observed ‘complete bacteriological cure at three months and radiological cure at the end of six months’ that are reported in an unspecified number of patients from an, as yet unpublished, study.