Robert B. Dienst

Streptomycin in the therapy of granuloma inguinale.

The use of antimonial preparations in the therapy of granuloma inguinale is well established. Its limitations, particularly in chronic cases, have long been known. Recurrences of the disease have occurred with a great degree of frequency even after apparent healing was attained. Other forms of treatment have been employed alone or in conjunction with the antimonials and have ranged from the local application of escharotic agents to surgery and x-radiation therapy. Although cure may be attained by adhering to one or another of these procedures, much is to be desired in the management of this minor venereal disease. With the advent of the antibiotics it was hoped that a more adequate and specific therapy for granuloma inguinale might be evolved. Preliminary observation with penicillin and tyrothricin showed that these drugs were of little value. One to 4 million units of penicillin administered for the expressed purpose of treating granuloma inguinale failed to control the granulomatous lesions. Tyrothricin was also without effect when it was applied locally in the treatment of granuloma inguinale. Streptomycin, however, has proved so strikingly effective in the therapy of granuloma inguinale that a preliminary report is warranted at this time. A total of 23 patients has received streptomycin for granuloma inguinale. The diagnosis of the disease was established in all cases by demonstrating the presence of Donovan bodies in either spreads made from the lesion or by histologic study of biopsy sections.† It is to be emphasized that no other form of treatment was instigated. The daily doses employed ranged from 0.3 to 1 g administered in 6 equal doses per 24 hours at 4-hour intervals. Total doses varied from 3.3 to 46 g given over a period of time extending from 6 to 46 days.

Practical Method for Determination of Serum Streptomycin Level Using “Donovania granulomatis” as Test Organism.

Conclusion The least amount of streptomycin that will inhibit the growth of the organism has been found by a similar procedure to be 0.075 γ/cc. Therefore, the serum streptomycin level is equal to 0.075 × Serum Dilution × Total Volume of Medium × 2. For example, if the endpoint of the assay is tube 5, which contains a serum diluted to 1: 16, the serum streptomycin level is 0.075 × 16 × 5 × 2 = 12 γ/cc. With this simple method, a serum level of 0.75 γ/cc to 48 γ/cc can be determined This range embraces the serum levels that are commonly encountered in streptomycin therapy. However, with slight modifications, such as using undiluted serum as the first tube and diluting the serum further, one is able to determine a streptomycin level from 0.375 γ/c to any level higher than 48 γ/cc.