Use Of Sulfonamides Research Articles

Effect of sulfonamide on gut microbiota after kidney transplantation

Objective To investigate the effect of sulfonamide administration after kidney transplantation on the intestinal microflora structure of transplant patients. Methods According to the inclusion and exclusion criteria, 10 patients who underwent renal transplantation at the All Army Organ Transplantation Institute of the No. 309 Hospital of the Chinese People’s Liberation Army from June to August 2016 were selected as study subjects. The stool sample of each patient was collected within 3 days before surgery and 30 days after surgery. A 30-day stool sample was prepared and a total of 20 stool samples were obtained. After the whole genome of the prokaryotic specimens was extracted, the 16S rDNA high-throughput sequencing method was used to analyze the bacterial structure. Results The number of operational taxonomic units (OTUs) after administration of sulfonamide was only half of the number of preoperative OTUs, and the difference was significant (P=0.003). Portal level: 10 bacteria were detected before surgery, and only detected after the use of sulfa drugs after surgery, and those of 8 bacteriophytas were detected after administration of sulfonamide postoperation. The bacterial abundances of 8 bacteriophytas also varied significantly before surgery and after administration of sulfonamide postoperation. The average relative abundances of the Phylum Firmicutes and Bacteroidetes decreased from 73.2% and 10.64% before surgery to 50.17% and 3.13% respectively after administration of sulfonamide. The average relative abundance of proteobacteria increased from 13.79% before surgery to 42.87% after administration of sulfonamide postoperation. For genus, the 20 kinds of bacteria with the highest preoperative abundance in the intestinal tract were mostly reported in the literature, or normal human commensal bacteria shown by studies, and after administration of sulfonamide, 20 new strains with the highest bacterial abundance in the intestinal tract were mostly pathogenic bacteria. Conclusion The use of sulfonamide after transplantation can significantly destroy the structure of the gut microbiota. The types of some commensal bacteria and probiotics are significantly reduced, and the pathogens are actually increased. Even intestinal immune and intestinal mucosal barrier functions were damaged. The abvove-mentioned may increase the risk of secondary infection to varying degrees. Key words: Kidney transplantation; Sulfonamide; Gut microbiota; 16S rDNA

Replacing Sulfa Drugs with Novel Dhps Inhibitors

More research effort needs to be invested in antimicrobial drug development to address the increasing threat of multidrug-resistant organisms. The enzyme DHPS has been a validated drug target for over 70 years as the target for the highly successful sulfa drugs. The use of sulfa drugs has been compromised by the widespread presence of resistant organisms and the adverse side effects associated with their use. Despite the large amount of structural information available for DHPS, few recent publications address the possibility of using this knowledge for novel drug design. This article reviews the relevant papers and patents that report promising new small-molecule inhibitors of DHPS, and discuss these data in light of new insights into the DHPS catalytic mechanism and recently determined crystal structures of DHPS bound to potent small-molecule inhibitors. This new functional understanding confirms that DHPS deserves further consideration as an antimicrobial drug target.

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

We report a case of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) secondary to trimethoprim-sulfamethoxazole (TMP-Sx) therapy for presumed community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection. Although the association between SJS/TEN and the sulfonamide class of antibiotics is well established, the increasing prevalence of CA-MRSA has left practitioners with limited regimens to effectively treat skin and soft tissue infections (SSTIs) in the outpatient setting. In the case of SSTIs, alternative treatment of these infections should be considered, especially when the bacterial pathogen is unknown. Future investigations evaluating the efficacy of adjunctive antibiotics for purulent SSTIs and monitoring the incidence of SJS/TEN in the era of CA-MRSA are necessary to reduce unnecessary use of sulfonamide drugs. The potential development of SJS/TEN, a severe life-threatening illness, emphasizes the need for judicious use of TMP-Sx and close monitoring and follow-up for patients who were given TMP-Sx for SSTIs.

Variations in gene organization and DNA uptake signal sequence in the folP region between commensal and pathogenic Neisseria species

BackgroundHorizontal gene transfer is an important source of genetic variation among Neisseria species and has contributed to the spread of resistance to penicillin and sulfonamide drugs in the pathogen Neisseria meningitidis. Sulfonamide resistance in Neisseria meningitidis is mediated by altered chromosomal folP genes. At least some folP alleles conferring resistance have been horizontally acquired from other species, presumably from commensal Neisseriae. In this work, the DNA sequence surrounding folP in commensal Neisseria species was determined and compared to corresponding regions in pathogenic Neisseriae, in order to elucidate the potential for inter-species DNA transfer within this region.ResultsThe upstream region of folP displayed differences in gene order between species, including an insertion of a complete Correia element in Neisseria lactamica and an inversion of a larger genomic segment in Neisseria sicca, Neisseria subflava and Neisseria mucosa. The latter species also had DNA uptake signal sequences (DUS) in this region that were one base different from the DUS in pathogenic Neisseriae. Another interesting finding was evidence of a horizontal transfer event from Neisseria lactamica or Neisseria cinerea that introduced a novel folP allele to the meningococcal population.ConclusionGenetic recombination events immediately upstream of folP and horizontal transfer have resulted in sequence differences in the folP region between the Neisseria species. This variability could be a consequence of the selective pressure on this region exerted by the use of sulfonamide drugs.

Dihydropteroate Synthase Gene Mutations inPneumocystisand Sulfa Resistance

Pneumocystis pneumonia (PCP) remains a major cause of illness and death in HIV-infected persons. Sulfa drugs, trimethoprim-sulfamethoxazole (TMP-SMX) and dapsone are mainstays of PCP treatment and prophylaxis. While prophylaxis has reduced the incidence of PCP, its use has raised concerns about development of resistant organisms. The inability to culture human Pneumocystis, Pneumocystis jirovecii, in a standardized culture system prevents routine susceptibility testing and detection of drug resistance. In other microorganisms, sulfa drug resistance has resulted from specific point mutations in the dihydropteroate synthase (DHPS) gene. Similar mutations have been observed in P. jirovecii. Studies have consistently demonstrated a significant association between the use of sulfa drugs for PCP prophylaxis and DHPS gene mutations. Whether these mutations confer resistance to TMP-SMX or dapsone plus trimethoprim for PCP treatment remains unclear. We review studies of DHPS mutations in P. jirovecii and summarize the evidence for resistance to sulfamethoxazole and dapsone.

A one year survey of meningococcal disease in Italy.

For the last ten years, meningococcal disease has been endemic in Italy with an annual average of 900 cases (rate of 1.6/100,000). The age specific attack rate has been highest for children under one year of age, and the majority of cases have been due to serogroup B. During 1985, the epidemiology of meningococcal disease changed substantially: twice as many cases were observed in males as in females. There was a shift toward older age groups, with the highest number of cases occurring in the 15-24 year old age group (25%). The frequency in army recruits was 17.3/100,000, as opposed to 1/100,000 for the general population. Serogroup C caused the majority of cases (75.8% of the isolates). The proportion of strains resistant to sulfonamides was 71.1%, while only one strain was resistant to rifampin and none to minocycline. Seven secondary cases occurred (2%): in five, chemoprophylaxis was inappropriate (sulfonamide), and in two, no drug was given. A single co-primary case was seen. We conclude that in Italy, the use of sulfa drugs as chemoprophylactic agents is not warranted at present, compulsory vaccination of army recruits with bivalent vaccine (A + C) is advisable, and the shift in age distribution of cases and the high predominance of serogroup C increases the need for careful surveys.

Elderly Parents as Caregivers for Their Adult Dependent Children

the area of parental caregiving with the aim these families. ents, and ambivalence about conflicts be of sensitizing those in the helping profes- tween duty to parents and duty to children, sions to a group of neglected families. First, In addition, providing care for individuals the essential role of elderly parents as the ——requires changes and adjustments in life major resource and support for their adult styles. Studies have found that caregivers disabled children and the stresses asso- the early 1940s with the development and are most likely to give up activities that have ciated with the responsibility will be widespread use of sulfonamide drugs, peni- some elasticity and are more marginal to described. Second, the limited knowledge cillin, and other antibiotics.3 Approximately personal and family equilibrium and sur and services available to elderly parents four million Americans are developmentally vival. Adjustments frequently occur in the and their children will be discussed. Third, disabled, with an estimated 50,000 to areas of free time for oneself, socializing with some implications for research and practice 315,000 elderly retarded persons, and the friends, taking vacations, having leisure that will enhance the functioning of these number is growing because of improve- time pursuits, and running one's own families as they age will be suggested. Be- ments in health care that contribute to home.9 For spouses and children who pro cause the families are neglected, their prob- longevity.4 While some of the individuals vide care, the caregiving generally starts lems are undefined and their needs unmet, may be placed in institutions, many live at later in life, but parents have had the care For effective practice with these families, home. For most of these individuals, family of their children from birth or very early in social workers need to know about them members are the primary caregivers, who the child's life, and their unique needs. provide most of the necessary assistance or In this article, dependency refers to any supervision. The Report to Congress by the cottdz-itc nv ctdpcc condition that interferes to some degree Comptroller General in 1977 found that oUUKlyB^ U* S1KLSS with a person's ability for normal role per- family and friends provide more than 50 Parents of adult dependent children face formance, limits mobility, or prevents the percent of the services received by develop- many demands for continuing their role as mastery of some self-help skills. The mentally disabled persons at all impair- parents. These demands extend far beyond disability also is lifelong or of extended ment levels and more than 70 percent of the time when such caregiving is termi duration. Individuals in this group may be the services received by the severely im- nated or greatly reduced for parents of mentally retarded, developmentally handi- paired.5 Many of the caregivers likely are nondependent children. The parents of capped, or mentally or physically impaired, parents, who themselves may be frail and adult dependent children deal with the issue The marked increase in the number of need some level of care as they cope with of perpetual parenthood, which becomes disabled persons in this country began in the stresses associated with providing care, more a reality as the parents and child age.

Alexander Ashley Weech, MD

Nov 10, 1985—Aug 17, 1977 A connoisseur of English and good wine, a teacher and scientist of repute, a physician of stature, and an editor par excellence has gone from our midst. He was a man of many talents, one of the giants of American pediatrics. Ashley will be remembered by generations of medical students and house officers whose habitat ranged from Baltimore to New York to Peking to Cincinnati to Gainesville; by clinicians for his early use of sulfonamide drugs in this country (see Am J Dis Child 124:818-819, 1972; 128:207-211, 1974); by scientists interested in plasma proteins and liver disease; and by the readers of thisJournal, which he so expertly edited from 1963 to the end of 1972. He had a fine editorial hand. A proponent of clear and precise phraseology and a believer in Bacon's dictum that writing maketh an exact man, Ashley saw to it

Textbook of Genito‐Urinary Surgery

The forty contributors to this textbook are all experts in the various phases of urology on which they have written. Prominent among the contributors are distinguished surgeons such as Swift Joly, Terence Millin, Clifford Morson and Jocelyn Swan. The book does not include every minor clinical entity in urology but should be useful to the student and to the experienced urologist. Several chapters are devoted to prostatectomy in all its aspects and are valuable. Discussion of the use of sulfonamide drugs and the newer antibiotics is up to date. The illustrations are excellent; especially noteworthy are those showing pathologic conditions as seen through the cystoscope. The discussion of bladder neck lesions is full and well illustrated. In general it may be said that this volume is a distinct contribution to urologic literature and its appearance should be welcomed by all urologists.

Textbook of Genito-Urinary Surgery

The forty contributors to this textbook are all experts in the various phases of urology on which they have written. Prominent among the contributors are distinguished surgeons such as Swift Joly, Terence Millin, Clifford Morson and Jocelyn Swan. The book does not include every minor clinical entity in urology but should be useful to the student and to the experienced urologist. Several chapters are devoted to prostatectomy in all its aspects and are valuable. Discussion of the use of sulfonamide drugs and the newer antibiotics is up to date. The illustrations are excellent; especially noteworthy are those showing pathologic conditions as seen through the cystoscope. The discussion of bladder neck lesions is full and well illustrated. In general it may be said that this volume is a distinct contribution to urologic literature and its appearance should be welcomed by all urologists.

PACHYMENINGITIS APPARENTLY DUE TO PENICILLIN HYPERSENSITIVITY

Case Reports1 April 1960PACHYMENINGITIS APPARENTLY DUE TO PENICILLIN HYPERSENSITIVITYLAURENCE FARMER, M.D., FRANCIS A. ECHLIN, M.D., WINIFRED C. LOUGHLIN, M.D., ARNOLD S. BREAKEY, M.D., ROGER DUVOISIN, M.D.LAURENCE FARMER, M.D.Search for more papers by this author, FRANCIS A. ECHLIN, M.D.Search for more papers by this author, WINIFRED C. LOUGHLIN, M.D.Search for more papers by this author, ARNOLD S. BREAKEY, M.D.Search for more papers by this author, ROGER DUVOISIN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-52-4-910 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptClinical and experimental observations(1-10) have established that protracted allergic reactions to drugs and foreign proteins may result in a variety of inflammatory and necrotizing tissue lesions. Such lesions, due to hypersensitivity to sulfonamides, penicillin, iodine, foreign sera and egg albumin, have been demonstrated mainly in the heart, lungs, kidneys, liver and spleen. In a patient under our observation there developed a marked pachymeningitis of the dura mater over both cerebral hemispheres, and a severe scleritis, apparently the result of an allergic reaction to penicillin.CASE REPORTA 47 year old woman suffering from excruciatingly severe, unrelenting headache was admitted to...Bibliography1. Rich AR: The role of hypersensitivity in periarteritis nodosa, Bull. Johns Hopkins Hosp. 71: 123, 1942. Google Scholar2. Rich AR: Additional evidence of the role of hypersensitivity in the etiology of periarteritis nodosa, Bull. Johns Hopkins Hosp. 71: 375, 1942. Google Scholar3. Rich AR: Hypersensitivity to iodine as a cause of periarteritis nodosa, Bull. Johns Hopkins Hosp. 77: 43, 1945. Google Scholar4. RichGregory ARJE: Experimental evidence that lesions with the basic characteristics of rheumatic carditis can result from anaphylactic hypersensitivity, Bull. Johns Hopkins Hosp. 73: 239, 1943. Google Scholar5. GregoryRich JEAR: The experimental production of anaphylactic pulmonary lesions with the basic characteristics of rheumatic pneumonitis, Bull. Johns Hopkins Hosp. 78: 1, 1946. MedlineGoogle Scholar6. FrenchWeiler AJCV: Interstitial myocarditis following the clinical and experimental use of sulfonamide drugs, Am. J. Path. 18: 109, 1942. MedlineGoogle Scholar7. French AJ: Hypersensitivity in the pathogenesis of the histopathologic changes associated with sulfonamide chemotherapy, Am. J. Path. 22: 679, 1946. Google Scholar8. MooreMcMillanDuff RHGCGL: The pathology of sulfonamide allergy in man, Am. J. Path. 22: 703, 1946. Google Scholar9. HawnJaneway CVCA: Histological and serological sequences in experimental hypersensitivity, J. Exper. Med. 85: 571, 1947. CrossrefMedlineGoogle Scholar10. Waugh D: Myocarditis, arteritis and focal hepatic, splenic and renal granulomas due to penicillin sensitivity, Am. J. Path. 28: 437, 1952. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: New York, N. Y.*Received for publication October 31, 1958.From the Lenox Hill Hospital, New York, N. Y.Requests for reprints should be addressed to Laurence Farmer, M.D., 993 Park Avenue, New York 28, N. Y. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byNeurological Adverse Effects Attributable to β-Lactam Antibiotics: A Literature ReviewContrast enhanced FLAIR imaging in ibuprofen induced aseptic meningitisDrug-induced aseptic meningitisDrug-Induced Aseptic MeningitisDrug-induced meningitisDrug- and Chemical-Induced Aseptic Meningitis: A Review of the LiteratureDrug-induced aseptic meningitisAseptic meningitis with retinal ischemia due to trimethoprim-sulfamethoxazoleRecurrent Encephalitis due to Trimethoprim IntakeTrimethoprim-sulfamethoxazole-associated aseptic meningitis: Case reports and review of the literatureTrimethoprim Associated Aseptic MeningitisPENICILLIN ALLERGY: A REVIEW OF THE IMMUNOLOGICAL AND CLINICAL ASPECTSInfluence of Penicillin Allergic Reactions on Venereal Disease Control Programmes 1 April 1960Volume 52, Issue 4Page: 910-914KeywordsAllergy and immunologyHypersensitivityLesionsMeningitisPenicillinSpleenSulfonamideTuberculosisUrticariaVision ePublished: 1 December 2008 Issue Published: 1 April 1960 PDF downloadLoading ...

Renal Papillary Necrosis

Renal papillary necrosis, called also necrosis of the renal papillae, necrotizing papillitis, and papillitis necroticans, is an uncommon condition, usually found in diabetic patients, although it may occur in non-diabetics. It has been recognized pathologically for many years, having been first described by von Friedreich in 1877 (1). Since that time 181 cases have been recorded, of which only 10 per cent failed to show evidence of diabetes, obstructive uropathy, or both (2). Because this disease is not well known, usually being discovered unexpectedly at necropsy, it is felt worthwhile to report a single case diagnosed radiographically during life. To our knowledge there has been no previous report of this type in the radiological literature. Olsson (3) in 1939 presented a case diagnosed by a gas pyelogram obtained as a result of fermentation of sugar in the urine of a diabetic. In 1945 Eskelund (4) published a case of necrotizing papillitis of the kidney following retrograde pyelography in a fifty-five-year-old female with pyelonephritis who died in a state of uremia, the diagnosis being based on post-mortem examination. In spite of the high mortality in these cases, the correct antemortem diagnosis is of more than academic interest, since the disease has two important characteristics that require a proper therapeutic regimen: (1) It is a suddenly developing and rapidly progressing necrotizing bacterial lesion that must be treated aggressively and without delay. (2) The selective necrosis involving the tips of the papillae impairs the urinary drainage of the associated nephrons, making definitely hazardous the use of sulfonamide drugs and related compounds with their known tendency to precipitate out in the renal tubules under conditions of urinary stasis or acid-base imbalance. Recent reports by Harrison and Bailey (5), Robbins, Mallory, and Kinney (6), Edmunson, Martin, and Evans (7), Robbins and Angrist (8), Muirhead, Vanatta, and Grollman (9), Swartz (10), and Garrett, Norris, and Vellios (11) all add emphasis to these points. Case Report A 55-year-old non-diabetic white male was admitted to the New York Hospital because of intermittent hematuria of three months duration. Cystoscopy revealed bleeding from the left ureteral orifice and poor function on the right. A right ureteral obstruction at 15 cm. was noted, together with an edematous and hemorrhagic appearing bladder mucosa. Blood clots were passed frequently. A chest film was negative for evidence of pulmonary disease. Blood pressure on admission was 180/110. The blood chemistry was within normal limits. Urine cultures yielded alpha Streptococcus, hemolytic Streptococcus, Staphylococcus aureus, and Corynebacterium. Smears and cultures on three separate occasions were negative for acid-fast bacilli.

Mortality in pneumonia and bronchopneumonia before the introduction of sulfonamide therapy

SummaryStatistical data are presented dealing with the course of pneumonia and bronchopneumonia prior to the use of sulfadrugs and antibiotics.The yearly and monthly distribution of cases and deaths is examined as is the influence of the age of the patients.

Thrombocytopenia following acetazolamide (diamox) therapy.

While thrombocytopenia is not common following the use of sulfonamide drugs, its occasional occurrence has been well documented. The widespread use of a new sulfonamide derivative, acetazolamide (Diamox), as a diuretic and acid-base regulator might be expected to result in thrombocytopenia in some of its uses. This report describes a case of thrombocytopenic purpura apparently caused by this drug. REPORT OF A CASE An 85-year-old white man was admitted to St. Luke's Hospital on March 18, 1954, with purpura and bleeding from the rectum of two days' duration. For years he had suffered from intolerance to fatty foods and intermittent pain in the right upper quadrant. In August, 1946, he had had a cholecystotomy with the removal of 13 gallstones. Postoperatively a biliary fistula developed accompanied by signs of biliary obstruction, which lasted until January, 1947. At this time he was admitted to St. Luke's Hospital for the first time,

Susceptibility of Neisseria gonorrhoeae to eleven antibiotics and sulfadiazine; comparison of susceptibility of recently isolated strains with results obtained in previous years in the same laboratory.

FOLLOWING the introduction and extensive use of sulfonamide drugs in the treatment of gonorrhea, increasing proportions of treatment failures from the use of these drugs were encountered.* Such treatment failures could be correlated with increased tolerance in vitro to sulfonamides by the strains isolated from the patients who responded poorly to sulfonamide therapy.† Fortunately, both sulfonamide-sensitive and sulfonamide-resistant strains of gonococci were found to be highly and equally susceptible in vitro to penicillin,‡ and infections with strains of both varieties responded equally well to treatment with this antibiotic.§ Increased tolerance to sulfonamides ∥ and to penicillin¶ could be induced by prolonged and repeated exposures of originally sensitive strains of gonococci in vitro. However, attempts to demonstrate penicillin-resistant strains of gonococci in cases of failures of penicillin treatment have generally failed,# and the rare reports of the isolation of such penicillin-resistant strains * have been dis- counted by other observers, who consider

RETROLENTAL FIBROPLASIA

Ninety-two per cent of the 66 cases of retrolental fibroplasia seen at the University of Chicago were born prematurely. No patients found to have retrolental fibroplasia were born at the Chicago Lying-in Hospital before 1937. The incidence of retrolental fibroplasia at the Chicago Lying-in Hospital from 1937 through 1945 was 6.8% of all survivals weighing less than 1600 gm. at birth; from 1946 through 1948, the incidence was 30.4% in the same weight group. The ratio of surviving infants born weighing less than 1600 gm. to the total number of surviving infants born at the Chicago Lying-in Hospital remained relatively constant from 1937 through 1948. The etiology of retrolental fibroplasia cannot yet be explained by prenatal bleeding or specific infection. Cutaneous angiomas cannot be said to have etiologic significance in retrolental fibroplasia since the incidence of cutaneous angiomas is no greater in infants with the disease than in premature infants in general. No relationship between the use of sulfonamide drugs and the development of retrolental fibroplasia can be established in this series of patients. An ocular disease of postnatal origin may be separated from the composite group. With this postnatal disease retinal detachment is the basic sign, prematurity is universal, and associated central nervous system and somatic defects are less common. A large increase in incidence of this postnatal disease occurred with a change in neonatal management. During the same period, no change in the incidence of the disease of prenatal origin was apparent. The change in neonatal management that could be related to the rise and fall in incidence was the use of a multiple vitamin preparation containing a synthetic emulsifying agent. An attempt to correlate the first appearance of or the changes in incidence of the disease at the University of Chicago was the first use of vitamin A or modification of the dosage of vitamin A was unsuccessful. It is suggested that the title retrolental fibroplasia be reserved tentatively for those infants who have bilateral retinal separation as a complication of extreme prematurity until an etiologically appropriate name may be proposed.

Paranasal sinuses in relation to skull injury; subsequent defects and their correction with tantalum plates.

For many years various types of materials have been employed in the repair of skull defects. The most recent substance to be used is the element tantalum. The contributions of Olsen, 1 Pudenz, 2 Burke, 3 Fulcher, 4 Robertson, 5 Baker, 6 Robertson and Peacher, 7 Schnitker and McCarthy, 8 Woodhall and Spurling, 9 Turner, 10 Gardner, 11 Echols and Colclough 12 and Bradford and Livingston 13 have done much to popularize the use of this element for such procedures both in military and civilian practice. Early debridement, skilful medical care and the use of sulfonamide drugs and antibiotics have been instrumental in saving large numbers of patients with compound depressed skull fractures. Of primary importance in the treatment of these patients is the debridement of the soft tissues, including the brain, dura and scalp. At this time a decision must be made as to whether the skull defect should

Medication Versus Sanitation in the Control of Coccidiosis

FOR YEARS experiment station and extension workers have recommended frequent removal of floor litter and replacement with clean material as a means of reducing the incidence of coccidiosis or preventing the disease in flocks. There is apparently general agreement that frequent changing of floor litter doe s reduce the number of oocysts present.Much information has been obtained concerning the use of sulfa drugs in the control of coccidiosis. An evaluation of the sulfonamides in the control of cecal coccidiosis can be found in the works of Levine (1939–41), Horton-Smith and Taylor (1942–43), Farr and Allen (1942), Hawkins (1943), Ripsom and Herrick (1935), Swales (1944–46), Seegar and Tomhave (1946), and Thorp et al. (1947). Delaplane et al. (1947) first reported the effectiveness of sulfaquinoxaline in the control of cecal coccidiosis under laboratory and field conditions. Grumbles et al. (1948 a, b, c, d) showed that sulfaquinoxaline could .

Consideration of glomerular nephritis in its relation to sulfonamide sensitivity

Three cases are reported of glomerular nephritis in which there were other pathologic lesions similar to those reported in cases of sensitivity to sulfa drugs. In two of these streptococcic endocarditis was present on the right side of the heart. Since glomerular nephritis is considered to be the result of a sensitivity reaction, the problem of use of sulfa drugs in diseases resulting from hypersensitivity is discussed. It is pointed out that a patient who becomes sensitized to one antigen may also become sensitive to a second antigen. Because of this, sulfa drugs should be used more carefully.

SUBACUTE BACTERIAL ENDOCARDITIS

The treatment of subacute bacterial endocarditis has been divided historically by most authors into three distinct periods of time. The first encompasses the period before the use of sulfonamide drugs, when it was estimated that the incidence of spontaneous recovery varied between 0 and 1 per cent. The second phase began with the use of sulfonamide drugs, either with or without fever therapy. Lichtman,1in an analysis of 704 cases falling in this group, computed the incidence of recovery to vary between 4 and 6 per cent. This was felt to represent a significant percentage increase. Since the advent of penicillin therapy, in the third period, a considerable number of authors have discussed the principles of treatment, the dosages used and the results obtained with penicillin. The percentage of cured patients has increased until it now is estimated to lie between 60 and 80 per cent. Some of the