H. Corwin Hinshaw

Streptomycin in tuberculosis.

Abstract Streptomycin is the most effective antibacterial agent known for tuberculosis. In vitro it has a marked bacteriostatic action on the tubercle bacillus, and in vivo it tends to exert a deterrent effect on the disease in both animals and man. Its therapeutic value is limited by the fact that after exposure to streptomycin for weeks or months, strains of Mycobacterium tuberculosis which are resistant to the effects of the drug may be isolated. Hence streptomycin is of most value in conditions in which temporary suppression of the infection will enable the patient to gain the ascendency over his disease; healing then occurs by natural processes. Prolonged arrest of the disease has been achieved by treatment with streptomycin even in cases of hematogenic tuberculosis, including generalized miliary tuberculosis and tuberculous meningitis. For these conditions large doses of streptomycin must be given parenterally for several months, and for meningitis intrathecal injections are imperative also during the early weeks of treatment. Other types of tuberculosis which have responded to treatment with streptomycin include exudative pulmonary disease, ulcerating lesions of the respiratory tract and tuberculous draining sinuses. It has some place in the treatment of bilateral renal tuberculosis or tuberculosis of a solitary kidney. It also is used before and after thoracic surgery for pulmonary tuberculosis. Because of the potential toxicity, use of the drug probably is contraindicated in conditions which will respond satisfactorily to the usual methods of treatment. Our knowledge of streptomycin is still in a state of flux. Now that the drug is undergoing extensive clinical investigation in many institutions its ultimate place in the treatment of tuberculosis will be determined in time. Experience with this antibiotic agent has proved that tuberculosis is a disease amenable to antibacterial therapy and it is hoped that other usable agents will be forthcoming.

STREPTOMYCIN IN TREATMENT OF CLINICAL AND EXPERIMENTAL TUBERCULOSIS

It is appropriate to discuss streptomycin at this time, which represents the second anniversary of the announcement of the discovery of this remarkable antibiotic substance. The nature and properties of strept,omycin wcre first described, two years ago this month, in the “Proceedings of the Society for Experimental Biology and Medicine,” by Schatz, Bugie, and Waksman, from Dr. Waksman’s laboratory, a t Rutgers University. The first two lots supplied to us were produced in Dr. Waksman’s research laboratory, and we are most grateful for the great effort which was required for its preparation. Subsequently, substantial amounts of streptomycin have generously been supplied to us by the research staffs of several pharmaceutical manufacturers, especially by Drs. Carlisle and Robertson, of Merck & Co. ; Dr. George Hazel, of the Abbott Laboratories; and Dr. Gifford Upjohn, of The Upjohn Company. Tuberculosis is a disease of such medical, social, and economic significance that great effort has been expended, for many years, in search for specific remedies. Many substances are capable of inhibiting or destroying the bacillus of tuberculosis in vitro. Robert Koch studied the action of compounds of gold and mercury on Mycobacterium tuberculosis, in 1890, and many unsuccessful efforts have since been made to apply this knowledge to treatment of experimental and clinical tubercu1osis.l Unfortunately, the many synthetic chemical substances which were effective in vitro were found to be ineffective in treatment of experimental tuberculosis of guinea pigs. Promin was the first synthetic substance which was found2’ to be capable of arresting the progress of well-established, experimental tuberculosis in This encouraging discovery has resulted in a renewal of the chemotherapeutic attack against tuberculosis. In addition to this prolongcd study of synthetic compounds, which has occupied the attention of the last two generations of chemists and bacteriologists, there has been a parallel, but less intensive, study on the effect of antibiotic substances on Mycobacterium tuberculosis.‘

PRESENT STATUS OF CHEMOTHERAPY IN TUBERCULOSIS

Excerpt The enthusiasm for chemotherapy of clinical tuberculosis which has been expressed by some authors of articles in newspapers and popular magazines is not as yet shared by most physicians who...

Antimicrobial therapy of tuberculosis in 1952.

Excerpt It has become almost traditional to open a discussion of this topic with the statement that antimicrobial drugs have yielded disappointing results in treatment of tuberculosis, having faile...