CERTAIN basic concepts, which have been discussed by Dubos, with respect to the triangular relationship between the drug, the parasite and the host, have generality not only in the field of tuberculosis but in the field of other infections. It might be of value to consider these principles in relation to the specific situation of the child who may have, or may have been exposed to, tuberculous infection.
Relationship between tubercle bacilli and isoniazid could conceivably occur in three different sets of circumstances: In the first circumstance the drug would be present in the extracellular and other fluids of the body before the tubercle bacilli were implanted. The second would be the circumstance in which the tubercle bacilli had already been implanted but the administration of the drug was started within a few hours or a few days of the implantation. The third would obtain if the tuberele bacilli had been present for a matter of more than a few days, and their multiplication had resulted in cutaneous sensitivity to tuberculin.
The first case, in which the drug was present before the bacilli, would not obtain in the United States, but only in circumstances in which one administered isoniazid in an area of high prevalence of tuberculosis with the notion that contacts of an infectious patient might have to be protected. Nevertheless, if these circumstances should obtain some of the tubercle bacilli received by the drug-treated host presumably might survive and if they did survive they would make no contribution to the acquisition of resistance by that host.
- Copyright © 1957 by the American Academy of Pediatrics