Intrathecal Penicillin in the Treatment of Meningococcal Meningitis

MacRae, Ronald (1947) Intrathecal Penicillin in the Treatment of Meningococcal Meningitis. PhD thesis, University of Glasgow.

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Fifty cases of meningococcal meningitis were treated with intrathecal penicillin alone, and a further fifty cases with sulphonamide and intrathecal penicillin. The patients treated entirely with intrathecal penicillin were given a dose of 50,000 units every forty eight hours. The cases which were treated with sulphonamides in addition to the penicillin received a smaller intrathecal dose of 30,000 units. Blood cultures were taken from 75 patients on admission and all were negative. The penicillin bacteriostatic titre of the cerebro-spinal fluid was estimated at forty eight hourly intervals after its intrathecal injection, and it was found that its excretion was rapid during the acute stage of the illness. The quantitative and qualitative changes in the polymorphonuclear leucocytes in the blood of patients suffering from cerebro-spinal fever were investigated. The eosinophil polymorphs were found to be absent or diminished during the early acute stage of the illness and their return to the blood was of favourable prognostic significance. The two groups of cases were compared and it was found that there were a slightly greater number of severely ill patients among those treated entirely with intrathecal penicillin. The results obtained from the treatment of the cases with intrathecal penicillin alone were disappointing. The fatality rate was 32%, and the incidence of hydrocephalus and gastro-enteritis was also high. In the cases which received sulphonamide in addition to the intrathecal penicillin the results were better. The fatality rate was lower by 18%, the illness was of shorter duration and not one of the cases developed hydrocephalus. Intrathecal penicillin, in doses of 50,000 units, produced toxic reaction in 22 cases which varied from lumbo-sacral pain to convulsions. The disease was, on the whole, more prolonged in all the cases which received intrathecal penicillin, and the results did not compare favourably with those of other workers using the sulphonamides alone.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: Medicine, Pharmacology
Date of Award: 1947
Depositing User: Enlighten Team
Unique ID: glathesis:1947-79633
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 04 Mar 2020 16:22
Last Modified: 04 Mar 2020 16:22

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