Local Penicillin for Ophthalmia Neonatorum

Abstract

persisted, and he began to expectorate blood-stained sputum.The tonsils were still greatly enlarged and covered by a yellowish exudate.Sputum examination for tubercle bacilli was negative.Blood culture on Sept. 2 gave a good growth of Staph.pyogenes (confirmed two days later, when another good growth was obtained).The organism had the following characteristics: a smooth moderately pigmented strain of Staph.pyogenes, non-haemolytic, coagulasepositive; penicillin sensitivity equal to that of the standard " Oxford " strain.It was now clear that the patient had a general septicaemia, and in spite of having received 12 g. of sulphanilamide and 25 g. of sulphathiazole he was getting steadily worse.Sulphathiazole treatment was stopped, and at 22.00 hours penicillin was given instead, in doses of 16,666 units, by intramuscular injection every three hours.The temperature at 22.00 hours was 102°F., and the pulse rate 110 a minute.No pathogens were obtained from culture of a throat swab.The total white cell count was still relatively low considering the nature of the infection-namely, 6,800 per c.mm., with 50% polymorphs, 27% small lymphocytes, 19% large lymphocytes, and 4% monocytes.On Sept. 3 and 4 a slight lowering of the temperature and some improvement in his general condition were apparent.On the 5th the temperature dropped to normal and was accompanied by a striking improvement in the patient's general condition and in the local appearance of the throat.The spleen was no longer palpable and the pleural friction rub could not be heard.Subsequent Progress.-Therewas a rise of temperature to 100°F.on Sept. 6 and 7 and to 99°F. on Sept. 9 and 10, but subsequently the temperature and pulse rate remained at normal levels.Penicillin was discontinued on Sept. 11, as the patient had now received 1,133,288 units.By this time all clinical evidence of septicaemia had gone and the appearance of the throat was normal.He continued to make an uneventful recovery, with no residual signs of disease in any system, and on Sept. 20 was evacuated to the United Kingdom for a period of convalescence.