Streptomycin in the Treatment of Human Tuberculosis

SUMMARY 1)The Veterans Administration has undertaken a large scale investigation into the clinical and toxicologic effects of streptomycin in the treatment of human tuberculosis. The treatment was given in accordance with the terms of protocols designed by representatives of the Veterans Administration, Army, and Navy, and was carried on in 20 cooperating Veterans Administration hospitals. 2)The results of treatment of 650 cases of various types of tuberculosis have been described. Because these are indicative of the fact that streptomycin exerts a favorable effect upon many types of tuberculosis, the present investigations are being continued and enlarged. 3)In some types of tuberculosis, namely, sinuses with cutaneous drainage, tracheo-bronchial, laryngeal and pharyngeal ulcerations, ulcers of the tongue and enteric tract and peritonitis, streptomycin has proved to be adequate and effective therapy when given by the intramuscular route. 4)In genito-urinary and in certain types of pulmonary tuberculosis, streptomycin has favorably altered the course of the infection in a majority of the cases. 5)The most beneficial effect in pulmonary disease occurred in exudative lesions. Less benefit was observed in fibrous, caseous, and cavernous lesions. No case was cured. 6)Bone and joint, ophthalmic and pericardial tuberculosis do not appear to be particularly benefited by streptomycin but experience with these lesions is meagre. 7)The expected mortality of meningeal and miliary tuberculosis has been lowered by the administration of streptomycin. 8)Toxic reactions upon the eighth nerve, kidney and organs of blood formation, and the delayed anaphylactic complications caused by streptomycin, preclude its use in all patients with tuberculosis. Its long term use must be accompanied by frequent and accurate laboratory procedures, and the disease under treatment must carry a prognosis sufficiently serious to justify the hazard of toxic effects from the drug. 9)Tubercle bacilli exposed to streptomycin eventually develop an overwhelming resistance to the antibiotic, so that the maximal therapeutic benefit to be anticipated will probably have taken place within 90 to 120 days in most cases. After resistance develops, further antibacterial therapy is probably useless, although this statement has not been decisively proved as yet. 10)It seems clear that streptomycin is capable of healing certain tuberculous lesions and of serving as an adjuvant to existing forms of therapy in other types of the disease. The precise indications for its use and the optimal dosage regimen have still to be learned in pulmonary, genito-urinary and bone and joint tuberculosis. The dosage schedule for treatment of respiratory, enteric and cutaneous ulcerations and disseminated tuberculosis is better defined. Further intensive and long term studies are necessary to learn how streptomycin can be most wisely and effectively used. 11)I should like to close by emphasizing, what I hope I have already made clear, that the work which has been described has been carried out by investigators in many Veterans Administration hospitals and that my function here today is simply that of a reporter of what I believe to be good deeds.