Charles H. Rammelkamp

Prophylaxis of acute rheumatic fever: By treatment of the preceding streptococcal infection with various amounts of depot penicillin☆

Abstract The prevention of acute rheumatic fever by penicillin therapy of acute streptococcal respiratory infections was attempted in this study. Procaine penicillin G in oil containing 2 per cent aluminum monostearate was injected intramuscularly according to one of three dosage schedules in 1,178 patients with exudative tonsillitis or pharyngitis while 1,162 patients remained untreated and served as controls. There was a total of ten patients who had received penicillin and forty-two patients who received no treatment in whom an illness classified as definite or possible rheumatic fever subsequently developed. Data collected on rheumatic subjects showed that reinfection with a new type of streptococcus frequently occurred when the interval between the onset of the observed attack of exudative tonsillitis or pharyngitis and the onset of rheumatic fever was prolonged. Excluding those cases of rheumatic fever developing after a forty-five-day interval between the two diseases results in two cases of rheumatic fever in the treated group and twenty-eight in the control patients. These data indicate that penicillin therapy of acute streptococcal infections almost completely prevents the subsequent occurrence of acute rheumatic fever. Penicillin therapy was also found to eradicate the streptococcus from the oropharynx of the majority of individuals and to inhibit the formation of antistreptolysin. The most marked inhibition of antibody was that obtained by three injections of penicillin over a ninety-six-hour period totaling 1,200,000 units in comparison to the suppression of antistreptolysin by either a single injection of 600,000 units or two injections of 300,000 units each given seventy-two hours apart.

Resistance of Staphylococcus aureus to the Action of Penicillin.

Conclusion Strains of Staphylococcus aureus vary only slightly in their susceptibility to the antibacterial action of penicillin. By growing the organism in increasing concentrations of penicillin over a long period it was possible to render the organism resistant to penicillin. Similar degrees of increased resistance were found in 4 strains of staphylococci isolated during the course of penicillin therapy for localized infections.

Effect of penicillin and aureomycin on the natural course of streptococcal tonsillitis and pharyngitis

Abstract A controlled evaluation of penicillin and aureomycin therapy in 475 patients with streptococcal exudative tonsillitis and pharyngitis studied by clinical, bacteriologic and immunologic methods is reported. Aureomycin was found to be somewhat more effective than penicillin in lowering the fever and causing rapid subsidence of symptoms. Both drugs exhibited slight action on the abnormal physical signs. They were equally effective in inhibiting antibody formation. Penicillin usually eradicated the carrier state whereas aureomycin failed to influence the incidence of convalescent carriers. Earaches seldom developed in patients treated with these drugs. With either drug early treatment is required if the disease process is to be materially shortened.

A Method for Determining the Concentration of Penicillin in Body Fluids and Exudates

Conclusions A method for determining the concentration of penicillin in various body fluids and exudates is described. It is possible by this method to determine 0.0039 Florey unit per 0.2 cc of solution.

Importance of the carrier state as a source of Staphylococcus aureus in wound sepsis

The relationship of pre-operative nasal and skin carriage of Staphylococcus aureus to wound colonization and sepsis was studied in 269 patients. Thirty-seven per cent of 96 carriers developed wound colonization as compared to 16 % among non-carriers (a statistically significant difference). The wound sepsis rates were 17 % and 9 % respectively. The combination of nasal and skin carriage was an important factor, since the sepsis rate among skin carriers (most of whom were nasal carriers as well) was 22%. Among carriers, the homologous strain was recovered from the majority of wound colonizations and from all instances of wound sepsis. A carrier strain also was recovered from 52% of the wounds colonized and from 50% of septic wounds in the entire study group. Profuse nasal carriage resulted in a significantly greater number of septic wounds (31%) than sparse carriage (9%). Wound cultures before closure, and skin from the initial incision site only once yielded a patients carrier strain or a strain of Staph. aureus that was later recovered from the wound. The results indicate that measures designed to control the carrier state or to isolate the wound from the external environment should reduce wound sepsis by approximately one half. Excellent technical aid was furnished by Eleanor Ford, R. N., Edith E. Silverman, Adrienne Marus, M. S., and Patricia Welch.

Excretion of Penicillin in Man.

Conclusions The excretion of penicillin in man may be partially blocked by the simultaneous administration of diodrast.

Transmission of Streptococcal and Staphylococcal Infections

Excerpt In 1955, Colebrook (1), a bacteriologist who had studied infections of burns and wounds during two world wars, reviewed the problem of the transmission and control of hospital-acquired infe...

HEMOLYTIC STREPTOCOCCAL PNEUMONIA AND EMPYEMA; A STUDY OF 55 CASES WITH SPECIAL REFERENCE TO TREATMENT

Excerpt It is now well established that at least 85 to 90 per cent of all cases of pneumonia are due to pneumococcal infections and, of these, at least 80 per cent are caused by a relatively small ...

Microbiologic aspects of glomerulonephritis

Abstract Through the study of the bacteriologic flora of the respiratory tract in patients with nephritis, it is becoming increasingly clear that the Group A streptococcus is responsible for the majority of acute attacks. The evidence is now sufficient to establish the fact that only a few strains of Group A organisms are capable of producing nephritis. Nephritogenic streptococci may usually be classified as type 12, 4, or Red Lake. Type 25 streptococci may also possess nephritogenic qualities. Further studies of these organisms may assist in the elucidation of the pathogenesis of acute glomerulonephritis.

Studies on the Absorption of Penicillin from the Stomach.

Conclusion Saliva, bile, and succus en-tericus obtained from man do not inactivate penicillin. Gastric juice destroys this antibacterial substance rapidly especially at body temperature. Hydrochloric acid, and not pepsin, is apparently responsible for this action of gastric juice. In 2 subjects with pernicious anemia the absorption of penicillin, when administered by mouth, was greater than that observed in normal subjects. The authors wish to thank Marjorie Jewell, Thelma Maxon, and Grace Helm for their assistance.