Streptomycin in Tuberculosis

Abstract

The immediate effects of crystalline streptomycin were studied in 44 patients with advanced pulmonary tuberculosis. The findings were evaluated in the light of results obtained in 31 patients treated with noncrystalline streptomycin, and in 11 patients treated with both forms. Viewed against a background of experience in the treatment of similar types of patients by conventional methods, it was found that: Crystalline streptomycin was associated with notable degrees of roentgenographic regression of the disease in approximately 60 per cent of patients with acute exudative, or recent caseocavernous tuberculosis. In a few it was associated with apparent arrest of the disease. The improvement was at a pace and to a degree seldom seen in similar types of patients treated on a rest regimen alone. In the remainder, the roentgenographic changes were rarely progressive under streptomycin treatment. They were either stationary or slightly regressive. Significant to marked symptomatic improvement occurred in the majority as evidenced in a decline of fever, decreased cough and expectoration, increased weight and improved well-being. Crystalline streptomycin was found to have no demonstrable effect on long-standing fibrocavernous tuberculosis. The potential toxic effects of streptomycin, particularly in older age groups, counterbalances any temporary improvement which may be derived from the use of the agent in this type of disease. Streptomycin was effective in the treatment of tuberculous laryngitis and bronchitis. Draining fistulas closed promptly, but occasionally reopened. It was of doubtful value in the treatment of chronic tuberculous empyemas, excepting possibly preoperatively. Streptomycin was found most valuable in conjunction with collapse and other surgical measures. In occasional instances it made surgical intervention unnecessary. Often it broadened the field of application of surgical treatment by rendering previously inoperable cases amenable to surgery. In the relatively small number of patients studied, no demonstrable differences could be detected in the immediate therapeutic effects in those treated with crystalline streptomycin as compared to those treated with the noncrystalline forms. It should be noted that the groups of patients in which the comparison was attempted were not treated simultaneously. Furthermore the patients treated with crystalline streptomycin had, by and large, more advanced tuberculosis often associated with serious complications. The toxic effects of crystalline streptomycin were, with few exceptions, not of a severity to cause abandonment of the treatment. Short interruptions were necessary in many instances. Crystalline streptomycin appeared to cause less pain at the site of injection and was less often associated with febrile reactions that the noncrystalline forms. However, stomatitis was more common with the former. Dizziness and allergic skin manifestations occurred with approximately the same frequency and intensity. The optimum daily and total dosages and the best manner of applying streptomycin were not established in this study.