"Myanesin" in the Treatment of Tetanus

Abstract

Failure was attributed to the low blood levels of sulphamezathine, and it was decided to repeat the course, using sulphamerazine in place of sulphamezathine, since it allowed higher blood concentrations to be reached without excessive dosage.For various non-medical reasons nearly two months elapsed before starting the second course on Feb. 2, 1948.Sulphamerazine, 2 g., was given orally at eight-hourly inter- vals for two doses, and subsequently 1 g.eight-hourly for seven days, to a total of 25 g.Penicillin, 400,000 units intramuscularly, was given concurrently three-hourly night and day, to a total of 24,000,000 units for the same time.Assay of the blood for penicillin, tested three hours after an injection, yielded a concentration of 3.2 units of penicillin per 100 ml. of blood.Assay of the blood for sulpharnerazine, tested at eight hours after an oral dose-i.e., just before the next dose-yielded a concentration of 12 mg. of total sulphamerazine and 7 mg. of free sulphamerazine.Stools were cultured daily for fourteen days after cessation of the course, and all were negative for Salni.typhi.Stool examinations were continued for the next nine months; three daily specimens were pooled and examined each week, making a total of 117 stools cultured.All cultures were negative for Salm.typhi, and it seems probable that the patient has been freed from the carrier state, though he will remain under observation for a further three months to complete a year's observation.It is noteworthy that his agglutination titre against a VI suspension of Salm.typhi had fallen from 1 in 20 to nil.