Streptomycin and promizole combined therapy in tuberculous meningitis in children

Abstract

~TREPTOMYCIN alone somethnes will cure tuberculous meningitis, formerly J a uniformly fatal dlsease. ~ ourteen patients wAh thls condltlon ]n thls hospital were given streptomycin alone; eleven died and three recovered, s However, Lincoln's results with combined streptomycin and Pro,mizole were so mueh more promising, 4 that we treated sixteen patients with a slight modification of her regimen. Patienls.--From June, 1948, to April, 1949, thirty-two patients suffering from tuberculous meningitis were admitted to The Shanghai Public IIospital for Children. Sixteen of them were treated with combined streptomycin and Promizolc, and six with streptomycin alone. The other ten were admitted too late in the course of the disease, died within one or two days of admission, or were discharged against advice soon after admission. Except for these drugs, al! of these patients received the same treatment. Of the sixteen patients treated with streptomycin and Promizole, the threeto four-month course of combined therapy was completed in six; five were treated for more than two months, and five, who are not included in this series, were observed for less than one month On admission, in addition to a careful history, physical examination, and routine laboratory tests, the following procedures were carried out : x-ray fihn of chest, examination of the fundi, testing of the eighth nerve, tuberculin test (PPD), sedimentation rate (ESR), plasma cholesterol determination, and cerebrospinal fluid examinations, including eell count, differential count, sugar, protein, and chloride determinations, and a seareh for tubercle bacilli by smears, B5wenstein.'s culture medium, or animaI inoculation. When the diagnosis had been established and treatment started, the above examinations and tests also were done daily or periodically as indicated. Treatment.--Streptomycin was given intramuscularly (0.1 to 0.2 Gin., every four ho,urs, according to the age and size of the patient, for from three to four' months) and intratheeally (25 to 50 rag. daily for thir ty days, and then every two days for sixty days). Also, from 1 to 1.5 Gin. of Promizole were given orally every day. It may be continued for from one to two years. In addition to the ordinary ward diets, extra nutrition, e.g., cow's milk, eggs, vitamins A, B~, By, C, and D were added. Patients who could not take food by mouth were fed by nasal feedings and those who vomited frequently were given fluids parenterally and Mood intravenously. As measles and whooping cough are the most serious complications of tuberculosis and may cause a relapse of tuberculous'meningitis, adult blood and immune globulin were given to prevellt