Hyperacute infections, i.e., infections which are often fatal within 24 hours from the onset of symptoms, and resistant strains of organisms, account for the vast majority of failures in the use of antibiotics. A few cases cannot be classified into either category and remain as unexplained failures.
The magnitude of the problem of hyperacute infections can be judged by the fact that in a contagious disease hospital about a third of the fatalities from nontuberculous, bacterial infectious diseases occur within the first 24 hours from the onset of symptoms. Meningitis due to meningococcus or pneumococcus, or meningococcemia, are most commonly encountered in this group. In Dr. Lepper's experience, those patients who will die within 24 hours from onset of symptoms can be predicted early from clinical observations, and they command "heroic therapy."
A lively discussion of the use of adrenal corticosteroids as pant of "heroic therapy" in hyperacute infections ensued. Dr. Riley pointed out that they are useful agents but have serious side effects and definite hazards. They are known to decrease the resistance of the host to infection. (The effect of cortisone on streptococcal infections in the rabbit was cited: 58 out of 66 rabbits pretreated with cortisone died; 5 of 60 control animals died.) Instances of empyema developing during treatment of pneumococcal pneumonia with both antibiotics and ACTH were described. The discussants agreed that at no time should adrenal corticosteroids be used in the treatment of infectious processes without simultaneous administration of adequate amounts of appropriate antibiotics.
- Copyright © 1959 by the American Academy of Pediatrics