Urinary Infections: Results of Treatment With Composite Long‐acting Sulphonamide (Dosulfin)

Abstract

IN spite of increased interest recently shown in the subject and great efforts directed towards it by the various drug houses, there is at the moment no perfect agent for the treatment of urinary infections. Since these are the commonest urological disorders encountered, research is not only important but promises to be endless. No sooner has one antibiotic or chemotherapeutic agent been introduced than some measure of resistance develops towards it and impairs its efficacy. New agents appear with such regularity that it seems almost impossible at times to keep abreast of the literature on the subject. Only a few years ago we had reached the point where chloramphenicol was regarded as the most potent broad-spectrum agent available, but since then other agents such as colomycin, kanamycin, cycloserine and nalidixic acid have been added to our armamentarium.In the excitement engendered by the arrival of each of these, it seems almost ingenuous to remind ourselves that the sulphonamides are probably still the best agents for the treatment of the commonly encountered, uncomplicated coliform urinary infections. A great deal has been heard lately of the new penicillin compounds, but the new composite long-acting sulphonamides have not enjoyed the same measure of publicity.The present investigation has been undertaken to observe the effect of treatment of sulphonamide-sensitive urinary infections with the long-acting composite sulphonamide known as Dosulfin (Geigy). Other aspects of urinary infection were given more general consideration at the same time.To date there have been several clinical trials with Dosulfin (Aufdermaur and Pulver, 1955;Cramer, 1956;MacFarlane, 1959). None of these trials has been concerned solely with urinary infections and all of them leave much to be desired in respect of the numbers involved, the thoroughness of follow-up, and the details of investigations carried out at the time. Dosulfin, in its pharmacological and early clinical aspects, has been well studied by Quattrin et al. (1955). It contains equal quantities of sulphaproxyline which is rapidly absorbed and reaches its maximum blood level within two hours, and of sulphamerazine which is slowly absorbed, taking much longer both to reach its maximum blood level and to be excreted. The individual components dissolve independently of one another according to the reaction to any given pH of the urine. The risk of crystallisation is low, even if fluids are not forced or if there is no concomitant alkali therapy. The antibacterial effects of the two components appear to be cumulative yet this does not apply to the toxic side-effects. Excretion appears to be almost entirely through the kidney so that low dosage and economy in use can go hand in hand with a therapeutically effective drug level.In this investigation adult patients of average body weight were given a loading dose of two tablets (1-5 g.) followed by one tablet eight-hourly for three days, then one tablet twice daily for eleven days. The total course, therefore, was over fourteen ...