Summary. This was the first retrospective clinical study of efficacy of common antibiotics (amoxicillin / clavulanate, clarithromycin, imipenem / cilastatin) administered ex juvantibus to differentiate pulmonary tuberculosis and community-acquired pneumonia (CAP). Administration of these antibiotics in 162 patients with confirmed pulmonary TB led to significant activation of pulmonary inflammation, extended infiltration of the lung tissue, cavitation and bronchogenic dissemination, culturing of M. tuberculosis from sputum and clinical worsening of the disease. On contrary, in 108 patients with CAP, the same antibiotics resulted in resolution of pulmonary infiltrates and relief of signs of the disease. Amoxicillin / clavulanate, clarithromycin and imipenem / cilastatin were proven not to have any effect on M. tuberculosis including those with MDR; they do not pertain to antiTB chemotherapeutic drugs.

The purpose of this investigation was to enhance the efficiency of differential diagnosis of pneumonia and pulmonary tuberculosis. A hundred and fifty-nine adult patients were examined. These included 78 patients with pulmonary tuberculosis and 81 with community-acquired p neumonia. The clinical features of infiltrative pulmonary tuberculosis (n = 48) and mild community-acquired pneumonia (n = 51) were compared. The course of caseous pneumonia (n = 30) was compared with that of moderate and severe community-acquired pneumonia (n = 30). Significant differences in the manifestations of the intoxication and bronchopulmonary syndrome were not found in patients with community-acquired pneumonia and infiltrative pulmonary tuberculosis. Physical studies showed that in patients with community-acquired pneumonia, moist rale (54.9%) and crepitation (11.8%) were prevalent, but in those with infiltrative tuberculosis rale was absent in 60.4% of cases and the pattern of respiration was unchanged in 79.2%. Chest X-ray studies indicated that in patients with community-acquired pneumonia, lower lobar inflammatory changes were predominant in 62.8% of cases whereas in those with infiltrative pulmonary tuberculosis the process was mainly bilateral (43.8%) with the presence of destructive changes (83.3%) and bronchogenic dissemination (66.7%). In patients with caseous pneumonia, the intoxication syndrome was more significant than in those with severe community-acquired pneumonia. Chest X-ray studies demonstrated that in patients with caseous pneumonia, specific changes were bilateral with the involvement of 2 lobes or more, with destruction and bronchogenic dissemination while in those with community-acquired pneumonia, the pulmonary processes were predominantly bilateral (76.6%) at the lower lobar site (36.7%).

In their everyday practice phthisiologists have to make a differential diagnosis and to treat patients with pneumonia who account for 2.7% of the patients treated at tuberculosis hospital. The main reason of diagnostic errors in patients with pneumonia in general hospitals is that the compulsory diagnostic minimum is not observed and the patients' sputum is not tested for acid-resistant Mycobacteria. The paper analyzes the results of treatment in 20 patients with pneumonia in the contagious isolation wards of the tuberculosis hospital, who were in-effectively treated in the outpatient setting. Multimodality treatment with broad-spectrum antibiotics, including rifampicin and streptomycin, aerosols, and physiotherapy may completely resolve infiltration and eliminate the clinical manifestations of the disease in 19 patients.