Streptomycin is the most effective tuberculostatic agent. It is unsuitable for prolonged therapy because of its potential toxicity, especially for the vestibular branch of the VIII C nerve, and because of the tendency of the tubercle bacillus to become resistant after relatively short periods of treatment.
Experience only will prove ultimately which lesions respond best to streptomycin therapy. Because of its limitations its use as a sole chemotherapeutic agent should be restricted to cases which can be benefited or cured by short courses of therapy not exceeding six weeks. It is of great value in controlling tuberculosis for short periods of time so as to permit surgical procedures and collapse therapy. Streptomycin is contraindicated in forms of tuberculosis such as primary infections and minimal chronic pulmonary tuberculosis which usually respond without chemotherapy. It should not be used in an attempt to prevent complications; meningitis and other less serious complications may develop during treatment.
Promizole® was found to be ineffective in the treatment of tuberculous meningitis; five out of seven cases of acute generalized miliary tuberculosis treated with promizole® have survived 2½ to almost five years and are free from miliary tuberculosis.
Combined therapy with streptomycin and promizole® was undertaken in order to utilize the advantages of the rapid action of streptomycin with the prolonged bacteriostatic action of the sulfone which can be given safely and effectively for a period of years. By combining the two drugs it was hoped to delay the emergence of resistant organisms and to secure an enhanced effect from both streptomycin and promizole®.
Ten children with miliary tuberculosis have been treated by combined therapy. One patient died after six days of treatment and another of a relapse from meningitis 11 months after the initial diagnosis of miliary tuberculosis. No relapse of miliary tuberculosis has occurred in patients treated with promizole® whether or not it was combined with streptomycin.
Eighteen cases of tuberculous meningitis have been treated with streptomycin by the intramuscular and intrathecal routes and with promizole® orally. Thirteen cases survived from 5 to 23 months. There have been no severe neurologic sequelae. All the survivors are apparently normal mentally.
- Received May 1, 1949.
- Copyright © 1950 by the American Academy of Pediatrics