Intermittent Dosage in the Treatment of Pulmonary Tuberculosis with Streptomycin

Bignall, John; Clegg, J. W.; Crofton, John; Douglas, Beverly; Holt, H. D.; Mitchison, D. A.; Armitage, P.

doi:10.1136/bmj.1.4664.1224

Cited by 15 publications

(6 citation statements)

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“…We have found an indefinite but slightly suggestive correlation between the general clinical severity of the case and the emergence of resistant organisms (Bignall et al, 1950). There are many exceptions to this trend but often very ill patients do produce tubercle bacilli with high degrees of streptomycin resistance and patients who are initially relatively well are a little less likely to do so.…”

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confidence: 60%

“…3 is derived from several American series (Mitchell, 1949;Howard et al, 1949;Howlett et al, 1949) and speaks for itself. In a recent series (Bignall et al, 1950) we have found a correlation between the degree of confluence of shadows in the radiograph and the time of emergence of streptomycin-resistant organisms. The more confluent the shadows the earlier resistant forms emerge.…”

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confidence: 89%

“…In both the series of cases of pulmonary tuberculosis treated with streptomycin with which I have been associated there has been a clear relation between the time at which streptomycin-resistant tubercle bacilli were first isolated and the degree of streptomycin resistance which was eventually attained (Crofton and Mitchison, 1948;Bignall et al, 1950). The earlier that resistant tubercle bacilli were isolated after starting treatment the more highly.resistant these bacilli eventually became.…”

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confidence: 99%

“…We have found that if routine examinations of the sputum are made in a patient with pulmonary tuberculosis under treatment with streptomycin there is usually an initial drop in positivity followed by a later rise (Crofton and Mitchison, 1948;Bignall et al, 1950). If this drop does not occur it is nearly always an indication that highly streptomycin-resistant tubercle bacilli will emerge.…”

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confidence: 99%

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Discussion on the Present Position of the Newer Antibiotics

1950

Proceedings of the Royal Society of Medicine

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If we survey the whole field of antibiotic research as it exists today , we find that these substances are being recovered from an extraordinary variety of sources in the plant kingdom. Apart from fungi and-bacteria, they have been extracted from alga, lichens, toadstools, bananas, sweet potatoes, wallflowers and hops as well as a variety of other plants. On the other hand, few of these thousands of substances qualify as chemotherapeutic agents and these few are derived from three major sources. They are first the higher fungi (Penicillia, Aspergilli) and here it is of some interest that in spite of the examination of many species, of which at least one-third form antibiotics of some kind, none has been found to yield a substance other than penicillin which can approach it in therapeutic efficacy. Another important source is the more primitive group of fungi, Actinomycetes, and these have been found to yield three valuable antibiotics, streptomycin, aureomycin and chloromycetin. Thirdly there are the aerobic sporogenous Bacilli, from which many named antibiotics are derived, the best studied of which are the polymyxins, bacitracin, licheniformin and ayfivin. Although a few enthusiasts dispute this, majority opinion is against the parenteral use of these substances on account of their toxic effect on the kidney. If this conclusion be accepted, we are left only with the antibiotics derived from Actinomycetes to form the subject of this Discussion. Since subsequent speakers are dealing with streptomycin, I shall confine my remarks henceforth to aureomycin and chloromycetin. (For discussion on streptomycin see p. 692). These antibiotics are formed by Streptomyces aureofaciens and Streptomyces venezuele respectively: the latter has also been synthesized, and in its synthetic form SEPT.-MED. 1.

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confidence: 60%

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confidence: 89%

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confidence: 99%

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confidence: 99%

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Discussion on the Present Position of the Newer Antibiotics

1950

Proceedings of the Royal Society of Medicine

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“…(Mitchell, 1949;Howard et al, 1949;Howlett et al, 1949) and confluence of shadows (Bignall et al, 1950). It will be seen that the distribution is similar except that fewer patients in the T1H group had gross cavitation and more patients in the T2H group had grossly confluent shadows than in the other groups.…”

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confidence: 96%