Sulphonamides in the treatment of meningococcal meningitis : report to the Scientific Advisory Committee / [by the Infectious Diseases Sub-Committee].

  • Great Britain. Department of Health for Scotland. Scientific Advisory Committee on Medical Administration and Investigation. Infectious Diseases Sub-Committee.
Date:
1944
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Licence: Public Domain Mark

Credit: Sulphonamides in the treatment of meningococcal meningitis : report to the Scientific Advisory Committee / [by the Infectious Diseases Sub-Committee]. Source: Wellcome Collection.

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    admission. If only those cases who survived 4 days are considered, some curious discrepancies are encountered. For, although in the age group under 2 years there is a decline in the fatality rate as the dosage increases, such a clear associa- tion between dosage and outcome is not seen in the other age groups. In the cases between 2 and 4 years the lowest fatality rate was encountered in those who received the smallest amount of drug ; while in those over the age of 15 years the lowest fatality rate was encountered in those who received medium dosage. It is difficult to account for these variations, for the total number of cases in each dose subdivision is reasonably large: it would have been expected that errors due to chance distribution would have been eliminated. In none of the other treatment groups is the number large enough to permit ~ such minute subdivision. It has already been pointed out that the cases which received combined treatment with serum and sulphonamides were given a slightly lower dosage of the drugs. We fully realise that the method of analysis adopted, entailing the selection of a particular group of cases, namely, those who survived a period of days in hospital, is open to criticism. Nevertheless, it does secure a series of cases which are wholly comparable in respect of the amount of drug which they were given during this period. Without a much more full analysis of the records it is only possible to draw the broad conclusion that a time has not yet been reached when it is possible to be dogmatic in regard to the optimum dosage. The figures in the Table indeed suggest that in this series the optimum doses for the different age groups are somewhat in excess of those prescribed by Banks ; they show, further, that rather more than half of the cases received a dosage in the first four days equal to or greater than that which he has advocated. ‘The high fatality rate encountered in this Scottish series, compared with that reported by Banks, can scarcely be ascribed to inadequacy of dosage, and suggests either that the series contains a greater pro- portion of fulminant cases, or that the disease, as seen in Scotland, during the epidemic period, was of a more virulent nature than that encountered in the South of England. DISCUSSION It is clear from the results tabulated that the introduction of the sulphonamide | group of drugs has caused a marked reduction in the mortality from cerebro-spinal fever. ‘The discussion of these results may best be centred round four main points. (a) Effect of Age. Clearly, age remains of great importance in the prognosis of this disease : the main mortality now falls on those under the age of 2 years and over the age of 35 years. This finding itself is of some importance for it shows that the problem of the treatment of cerebro-spinal fever is not yet completely solved. It may be argued that the inhibitory effect of the sulphonamide drugs upon the meningo- coccus is not likely to be dependent upon the age of the patient. Such a contention — would suggest that there must be some factor in the disease-process at these ages which prevents the complete success of chemotherapy. It may be noted that in pneumonia too a relative lack of success with sulphonamides has been found in the older age groups (Anderson, 1943). ‘There is apparently a factor involved in effective chemotherapy quite apart from the mere exhibition of the drug. (b) The Effect of Different Methods of Treatment. There are practically no clinical therapeutic trials of the sulphonamides which — permit a comparison between the effects of the different drugs. For such a com- parison to be accurate it is essential that the drugs be administered during the same _ period of time to cases of a disease chosen by some method, such as an alternating one. The figures in the present report are no more accurate in this respect than are others: clearly an undue proportion of the cases received one drug only— namely, sulphapyridine. So far as the fatality rates and the rapidity of cure as