Thirteen Cases of Influenzal Bronchopneumonia in Children
Authors: D. M. Morgan, J. D. Pickup
Journal: BMJ (1958)

MEDICALoSRL 263The bacteriological findings in the 16 cases which required a change of treatment were not significantly different from those in other cases, with the exception of/three penicillin- treated cases in which resistant forms of H. influenzae were found.Secondary infection with antibiotic-resistant organ- isms, however, was much commoner in all cases given peni- cillin (28 out of 42) than in those treated initially with chlor- tetracycline (12 out of 41).Virus studies showed that there was serological evidence of recent infection by influenza virus A in 10 patients, by influenza virus B in one patient, and by a virus of the psittacosis group in another patient.Of these 12 patients, nine were given chlortetracycline and three penicillin.Comment Pneumococci and H. influetnzae appear to be the most important pathogenic organisms consistently found in the sputa of patients suffering from bronchitis (May, 1953).The frequency with which they may be isolated from the sputum of such patients has been confirmed in the present trial; moreover, out of 10 fatal cases the sputum of nine con- tained pneumococci and that of four had H. influenzae.Clearly, therefore, treatment should be designed to eliminate these two organisms, preferably by using a single antibiotic.It has been suggested (Brit.med.J., 1954; Flint, 1954; Lancet, 1954) that the tetracyclines are more effective for this purpose than penicillin.In this series of cases the results throughout favoured treatment with chlortetracycline, and patients who received penicillin more often required a change of antibiotic on clinical grounds alone.It is probably of greater significance, however, that the penicillintreated cases were more readily infected with H. influenzae during treatment than those which received chlortetracycline.Eight of the 10 fatalities occurred in patients who were suffering from heart failure, and there was no apparent difference in the effect of the two antibiotics on these cases.In the cases which recovered chlortetracycline was apparently more effective than penicillin, whether heart failure was present or not; this result was obtained in spite of the greater incidence of H. infliuenzae in the cases without heart failure.Moreover, there was a higher incidence of recent respiratory virus infection among the cases treated with chlortetracycline.In both diagnostic groups of the series the incidence of pneumococcal infection was equal, thus suggesting that the better effect of chlortetracycline on H. influenzae was the deciding factor in favour of this anti- biotic.This view is supported by the work of Gabrielsen, Lynn, and Leedham (1954), who showed that chlor- amphenicol or chlortetracycline was more effective thati penicillin in eradicating infection with H. infiuenzae.Toxic effects were negligible even in those treated with chlortetracycline, thus confirming earlier work from this hospital (Brit.med.J., 1956).It can therefore be concluded that for routine use chlor- tetracycline is preferable to penicillin in the treatment of acute exacerbations of bronchitis, regardless cf whether the infecting organism is H. influenzae or the pneumococcus.All the tetracyclines have similar properties, however, and any one of them could be expected to produce results com- parable to those of chlortetracycline.In this trial no attempt was made to assess the value of penicillin and streptomycin given concurrently ; this com- bination of antibiotics is possibly the most effective treat- ment for infections with H. influenzae (Mulder, Goslings, van der Plas, and Lopes Cardozo, 1952), although large doses by intramuscular injection are essential.Summary A controlled trial of chlortetracycline (" aureomycin") and penicillin in 84 cases of bronchitis is reported.There were equal numbers of cases in each treatment group, but 37 patients also suffered from pulmonary heart disease.Pneumococci and H. influenzae were the pathogenic organisms most often isolated from the sputum.