1.5 topical neomycin in cervical and viginal infections with special reference to bacillus proteu
TRANSCRIPT
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8/10/2019 1.5 Topical Neomycin in Cervical and Viginal Infections With Special Reference to Bacillus Proteu
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S.A. M ED IC AL JO UR NA L
1 January 1955
TOPIC L NEOMYCIN IN CERVIC L N . V GIN L INFECTIONS WIT
SPECI L REFERENCE TO CILLUS PROTEUS INFECTIONS
WERNER
WEINBERG,
M R RCH RAND , M D BERLIN
Johannesburg
Antibiotics has been a
boon
in the treatment
of
cervical
and
vaginal infections, especially
in
their relation to
sterility. Even chronic cases have reacted surprisingly
well to antibiotic therapy and the question of topical
applications directly to the cervix and intracervically
has been discussed by the
author
before.
I
, 2 Aureomycin,
crysticillin, streptomycin
and
sulphonamides have been
used for this purpose
in
the form of ointments or
solutions.
The
oral
and
parenteral use of antibiotics
guided by sensitivity tests yielded good results,
but
their
topical use has not been very successful, especially in
chronic cases and in particular in bacillus proteus
infections.
It is a well-known fact that R proteus in the cervix
and vagina is extremely resistant to treatment.
In
bladder infections intramuscular streptomycin has
proved successful,
but
in cervical and vaginal lesions
neither streptomycin nor other antibiotics or chemo
therapeutic agents have been of any distinct value.
Frequently proteus is not found
in
the original vaginal
and cervical culture, but appears only after the dis
appearance
of the primary bacillary infection, particularly
haemolytic streptococci and staphylococci. Seeing
that
many of the oral antibiotics cause a slight diarrhoea, may
it be possible that they predispose to the appearance
of
the proteus,
or
does this scavenger
appear
only after the
primary pathogens of cervix and vagina have been
destroyed?
The
spermicidal tendencies of
Escherichia coli,
Streptococcus viridans,
haemolytic streptococci, staphylo
cocci and
Proteus vulgaris
are well known.
2
, 3
I
advocated
the
combination of oral
or
parenteral anti
biotic treatment with local antibiotic intracervical
and
vaginal therapy
in
order to obtain the best results in
cases of infection and found it therefore of interest to
investigate the efficacy of neomycin-sulfate cream
Myciguent Cream ; which was kindly put at my disposal.
T M nil
T M ni l
T nil
yes
C
nil
T EC, BP
nil
SM StaAuH n
BP
T StaAuNH StaAuNH
T M M
yes
yes
yes
yes
yes
yes
yes
yes
yes
Pregnant
after
treatment
nil
nil
M
nil
nil
nil
nil
nil
ni l
BP
nd
bacterial
flora
after
treatment
nil
StaAuH nil
T
nil
nil
nil
M
BP
nil
T
BP
Str
BP,
T
BP
nil
BP
M
StaAuH nil
StaAuNH
StrNH nil
BP
nil
nil
BP ni l
BP
BP
1st
bacterial
flora
after
treatment
StrV
BP
nil
nil
T nil
SM
SM
C
T
T
SM
T
C
T
C
T
T
E
T
T
T
C nil
T
SM
T
T
T
E
T
T
nti
biotic
used
TABLE [
continued
7 EC, BP
8
BP
9
BGNH
StrNH
IO EC,
BD
StaAuH
BP
EC, BP
12 StrH
StaAuH
BD
13
BP
14 L, StrH
15 StaAuH
BD
16
BP
StaAuNH
17
StrH
18 StaAuH
T
19 StaAuH
StrV,
BD
StrH
20 StrNH
StaAuH
BD,T
21
T, BP
StaAlb
22
StaR, BD
23
StrH
StrNH
24
StaAuH
25 StrH,
BC
StaAuH
26 StaAu
27
StaAu
BD,
M
28 BC, M
29
StaAuH
BD
30 StrH, BD
31
StrNH
Sta H
32 StaAuH
BD
33 StaAuH
34
StrH
35
StaAu
T
36
StrV
BD, BP
37
StaAuH
BD
38
StaAu
St r H
BD
39 StaAuH
BP
40
EC,
BP
Number
of Bacterial
cases infection
yes
yes
yes
Pregnant
after
treatment
nil
nil
nil
2nd
bacterial
flora
after
treatment
nil
nil
M
St r H
StrV
BP
StrV.
StaAlb
BP
StrV
BP
1st
bacterial
flora
after
treatment
nil
TABLE I
T.
T.
T.
T
T.
T.
nt i
biotic
used
5 StaAuH
BD
StaAuH
BD,
BP
2 BC,BP
3 StaAuH
StaNH
BD.
4 StaAuH
StrV.
6
StrH
BP
Number
of Bacterial
cases infection
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BP
nil
15
Streptomycin.
Terramycin.
SM
T
Haemolytic Staphylococcus aureus.
on-haemolytic Staphylococcus aureus.
Haemolytic Staphylococcus.
on-haemolytic Staphylococcus.
Haemolytic Streptococcus.
on-haemolytic Streptococcus.
Streptococcus viridans.
Trichomonas.
Crysticillin.
Erythromycin.
StaAuH . .
StaAuNH
StaH
StaNH
StrH
Str H
StrV
T
Drugs:
C
E
Mrs. H.S. was trying to have
an
inf ant f or 9 years an d was
suffering from cervical an d vaginal.bacterial infection with hae
molytic Staphylococcus aureus an d Streptococcus viridans. Oral
tre atme nt with 48 c apsule s Ter ra mycin m gm 250 ove r 8 days
an d
daily intracervical
and
vaginal topical application
of
neomycin
c re am was institute d: The second bacteriological examination
carried ou t
8
days after therapy was commenced showed monilia,
non-haemolytic streptococcus, Streptococcus viridans and Pro-
teus vulgaris.
Th e patient was then treated daily
for 10
days with
topical application of neomycin alone; the third bacteriological
examination showed
no
pathological organisms
an d
within
3
weeks from the beginning of treatment the patient pregnant.
In most cases th e second bacteri610gical examination
was done within 8 days
of
the institution
of
therapy and
if
the necessity arose a third one within 3 weeks from the
beginning
of
treatment.
No
side-effects have been observed f ro m t he use
of
topical neomycin. Neomycin did no t affect trichomonads
or
monilia.
Th e
most interesting finding was the almost specific
effect on
Proteus vulgaris.
Th e incidence
of
this organism
an d
the effects
of
treatment are shown
in
Tables
II
and
Ill.
Table I tabulates results
in 7
cases
of
cervical an d
vaginal infection. In all cases or al or parenteral anti
biotic treatment has been combined with repeated
topical intracervical and vaginal application
of
neomycin
sulfate cream.
The
general and topical use
of
antibiotics
i n the tre atme nt
of
cervical
an d
vaginal infection ha d
considerably improved the likelihood
of
cure, bu t the
topical use of neomycin combined with oral or parenteral
antibiotics has further increased the percentage
of
cure.
In a previous communication 2 prior
to the
intro
duction
of
topical neomycin) I was able
t o r ep or t t ha t
in
34 cases
of
cervical and vaginal infection pregnancy
resulted in
12
cases 34
after treatment by the general
and topical use
of antibiotics . Af ter t he combi ned use
of
antibiotics and topical neomycin pregnancy resulted
in
31
out
of 7
cases treated i.e. 44.5
.
This
is
a cons iderabl e i mpr ovement, especially as
cases
of
very long standing responded surprisingly well.
I would like to quot e case 4:
V I R G EN E E S K UN DE
yes
yes
yes
Pregnant
after
treatment
nil
nil
nil
nil
nil
M
T
yes
nil
ye-s
M yes
yes
ye-s
yes
yes
yes
nil yes
nil yes
nil yes
nil yes
yes
nil yes
TYDSKRIF
2nd
bacterial
flora
after
treatment
T nil
T BP
C nil
T nil
T nil
T
StrH
StaAlb
BP
E nil
SM BP
C BP
T M
T T BP
T
nil
T BP
T nil
T nil
T nil
C M
T
BP
T
BP
SM StaAuH
M
T
BP
T
BP
T
BP
T nil
T BP
S
T nil
T nil
T
BP
T nil
1st
n ti bacterial
biotic flora
used after
treatment
T nil
TABLE I
continued
41 StaAu
BD
4
StrV
StaAuH
BD
43 StaAu, M
44 StaAuH
StaAu H .
45
StrV
StrH
46 BP
StaAuH
47 StaAuH
StaNH
BD
48 BG N
49 EC , BP
50
StaAuNH
BD
51 T, StrH
52 T, StrH
StaAlb
BD
53 StaAuH
BD
StaAuNH
54 StrH
StaAuH
StaAuNH
55
EC , BP
56 StaAuH
BD, BP
57 StrNH
StrV, BD
58 StaAu
T,
BD
9 StrV,
T, BD
60
StaAu
BD
61 EC, BD
StaAu
62
StrV,
BD
StrNH
63 StaAu,
BP
64 StrH
StaAu
65 StaAu,
T BP
66
StrNH
BD
67 StaAuH
BP,
BD
68 T,
StaAuH
69
StaAlb, T
70 StaAu,
BP
Number
o
Bacterial
cases infection
Januarie 1955
TABLE
II.
INCIDENCE OF BACILLUS PROTEUS
Bacillus proteus present Cases
In
mixed bacterial infections before treatment . .
21
I n the first bacterial flora after treatment 28
Fo r th e
first time in the bacterial flora af ter
treatment
17
Persisting in t he second bac t erial flora aft er
treatment 2
Bacteria:
BC
BD ..
BG N
BGNH
BP ..
EC
L
M
StaAlb
StaAu
Coliform bacillus.
Diphtheroid bacillus.
Gram-negative bacillus.
Haemolytic gram-negative bacillus.
Bacillus proteus.
Escherichia coli.
Leptothrix.
Monilia.
Staphylococcus albus.
Staphylococcus aureus.
Total . .
38
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S M E D IC L J O UR N L
1
January
1955
TABLE I II. RESULTS
OF
TREATMENT
Bacillus proteus present Cases
Responding
to
initial
treatment
with anti -
biotics and topical neomycin . . 10
Responding
to
topic al neomycin a pplica tion
alone 26
Resistant
to
topical neomycin 2
Total
38
Thus the proteus infection was eradicated in
36
out .
of 38 cases.
Of the 38 cases of p ro te us i nf ec tio n t rea te d w it h
antibiotics and topical neomycin
18
resulted in preg
nancy.
I attribute these excellent results
to
the application of
topical neomycin and I recommend its use in proteus
infections.
SUMMARY
1 Seventy cases of cervical
and
vaginal infection, of
which 31 resulted in pregnancy, have been presented.
2
All these cases have b ee n t re at ed with
the
appro-
priate antibiotics
in combination
with topical neomycin.
3.
Amongst these
70
cases t he re were
38
cases of
infection with Proteus vulgaris
4. Ten cases of proteus infection responded
to
initial
treatment with antibiotics and topical neomycin and
26 to the use of topical neomycin alone; i.e. over 90
of
cures.
5. Of 38 cases
of
proteus infection 18 cases resulted in
pregnancy after treatment.
6 The use of topical neomycin alone or in combina
tion
with other antibiotics is of distinct value in cervical
and vaginal infection, especially when bacillus proteus
is present.
am
grateful
to Dr.
Harold R. R eam es , P h. D: , M.D.
Medical Division
Department of
Clinical Investigations, The
Upjohn Co mp an y, Ka la rna zoo , Michigan, who su ppl ied t he
neomycin-sulfate cream Myciguent Cream).
My special thanks are furthermore
due to
Dr . W. Lewin,
Patho-
logist, Johannesburg, for the bacteriological work.
REFERENCES
1.
W ei nb er g, W. 1948): S. A fr . M ed . J ., 2 2, 5.
2 Idem 1953): Ibid 27, 1032.
3. Mat th ews , C. S. and Buxton, C. L 1951): Fertil. and Steril.,
2,45.
R VISION S RI S
V.
TH M N G M NT OF M L RI
MICHAEL GELFAND.
G E M.D. CAPE
ToWN),
F.R.C.P.
D.P.H.
Physician Salisbury Native Hospital
Too muc h emp hasis has p er ha ps b een placed on what
constitutes the dosage of an anti-malarial drug, since
most assessments refer
to
cases of average severity.
Any such estimation, especially
in
a disease like malaria,
tends to overlook the clinical condition
of
the patient.
O ne c an no t p re di ct how much of the seleCted drug is
required or how long the course will last.
The
principle
applies to any state of fever bu t in
no
disease
perhaps
is this point
of
greater significance than
in
malaria,
for failure to appreciate it may mean the loss of a life.
THE SEVERE GROUP
Before deciding
on the
dosage
and
method of admini
stration of an antimalarial drug, one must assess the
clinical state of the patient. Signs of severity are indicated
by:
Restlessness.
2
H ig h fever f or 2
or
more days.
3 Vomiting repeated).
4. Severe and persistent headache.
5 Although a r ough guide , the more parasites r field as seen
microscopically
in
t he p er ip he ra l b lo od , t he mo re s eri ou sl y il l is
the patient.
These -features are more l ikely to be met in the non
immune subject exposed for the first time, although
this ru le is
not
absolute; in an immune subject a heavy
infection occasionally occurs and the pat ient may be
dangerously ill. Generally speaking, any of the following
may be regarded as belonging to the serious or poten
tially serious group:
I.
Acute fever in
an
infant
or
child.
2. A cu te fever asso ciated w it h dy sent er y or severe diarrhoea.
3. Acute fever with jaundice bilious remittent fever).
4. Signs of collapse with a weak pulse, a fever which is moderate
or only slight,
and
signs of renal impairment protein and casts
in t he u ri ne and a r aise d
blood
urea).
5. A cu te fever i n a pe rs on beyo nd mi ddl e age infected for t he
first time.
6
An
untreated case of acute fever of a few or several days
duration.
Forthe severe group quinine is the drug which should
be employed unless its use is contra-indicated; for it
has a rapid and specific a cti on w ith a marked effect
against asexual erythrocytic parasites.
When
a su bje ct
w ith m ala ria is acutely ill, qu in in e is given at first b y
intravenous injection but subsequent doses are admini
stered according
to
the condition of the patient. This
must depend en the practitioner s own judgment. If there
is much vomiting, signs of collapse, loss of fluid or
delirium, an intravenous drip infusion glucose-saline)
is set up at once and quinine dihydrocWoride gr.
1
for a n adult,
half
this
amount
for a child
and abou t
gr 4 for
an
infant) is injected into the rubber connection
o t i nto
the bottle), th e d ri p flowing in
at
a
rate
of
30 drops per minute. This method ensures a slow,
steady
and
safe administration of the drug. T he quin ine
is repeated in the same way every 6 hours until the