- Email: [email protected]
CHLORAMPHENICOL IN WHOOPINGCOUGH
400 SUMMARY
Perforation of a duodenal ulcer 15 months after vagotomy is reported. Only two other cases have been traced and in both of these the perforation occurred within a month of the vagotomy. The remarkable feature of the present case was the lack of rigidity after perforation. Pain, however, was severe, and shock was
profound.
My thanks are due to Mr. Ivor Lewis for permission to publish this case and for his criticism, and to Dr. D. Ferriman who referred the
case
for surgery. REFERENCES
Alvarez, W. C. (1948) Gastro-enterology, 10, 413. British Medical Journal (1948) ii, 652. Johnson, H. D (1948) Brit. med. J. ii, 760. Walters, W., Neibling, H. A., Bradley, W. F., Small, J. T., Wilson, J. W. (1947) Arch. Surg. 55, 151. Weeks, C., Ryan, B. J., Van Hoy, J. M. (1946) J. Amer. med. Ass. 132, 988.
CHLORAMPHENICOL IN WHOOPINGCOUGH REPORT ON 5 SEVERE CASES
JAMES MACRAE M.D. Glasg., F.R.F.P.S., D.P.H. RESIDENT PHYSICIAN, HAM GREEN HOSPITAL, BRISTOL
of small infants with whooping-cough has anxious work. The case-fatality is high under the age of 3 months, and moreover the pulmonary complications of whooping-cough in infancy often remain as a permanent disability and may shorten the patient’s life. When it was reported in July, 1949, that chloram-
THE
care
always been
phenicol
was
active
against Hcemophilus pertussis
in vitro and in experimentally infected animals, a small stock of the drug was obtained and set aside for the treatment of infants with severe whooping-cough. Since then, five infants have been so treated. The cases were selected as being severely ill, with a poor prognosis, but at a relatively early stage of the disease before secondary infections had been added. There was no clinical doubt of the diagnosis, which is sometimes difficult in small infants, and there was clearcut evidence of direct contact with other cases of whooping-cough in every case. The dosage, which was necessarily rather guesswork, was based on a minimum of 50 mg. per kg. of bodyweight daily, with a generous increase in view of the severity of the infection and the low toxicity of the drug. Each baby received 0-25 g. as a first dose and thereafter 0-125 g. 6-hourly for 7 days and 0-125 g. 12-hourly for a further 7 days. It may be that these doses can be reduced as more experience is gained.
Administration of the drug was not difficult. The capsules were opened and the unprotected powder given by mouth in a little black-currant juice (’ Ribena’) by teaspoon some minutes before a feed. It was rather surprising to see this bitter-tasting drug go down so easily. All the infants were nursed in complete isolation throughout the illness. The feeds the baby had been accustomed to before infection were continued, and replacement feeds with, if necessary, replacement doses of chloramphenicol were given to allow for vomiting. Careful records were made of coughing spasms and vomiting. No other drugs were given.
The details of the five cases are summarised in the table. The consistent gains in weight are remarkable considering how ill the infants were at the start of treatment.
accompanying
Case This infant was badly cyanosed on admission and having almost continuous ineffective spasms of coughing intermingled with tiny vomits. She was given oxygen without great effect for 24 hours. Great improvement was noted 12 hours after chloramphenicol was started, and general recovery was complete in 48 hours. Thereafter coughing spasms were short-lived and mild. was
This child’s life was despaired of by her mother and her recovery was regarded as a miracle by the parents. Even the more knowledgeable and disinterested nursing staff regarded the recovery of this first case as very remarkable. Case
2.-Though
=
spasms.
so
severely
ill
as case
1, this little
was
spasms became innocuous. Case 3.-This little boy was as ill as case 1 and his recovery was equally dramatic, being complete in 24 hours. Cases 4 and 5 ran a very similar course. Initially the exhausting, very protracted, coughing spasms were obviously useless and becoming more distressing each time. Some cyanosis was constantly present and the infants had become terrified of
coughing
severely
feeds because they brought on spasms of coughing. After 12 hours of chloramphenicol a remarkable repose was noted, and though coughing continued for a time it was obviously no
longer
a
terrifying experience. SUMMARY
Five infants severely ill with whooping-cough were treated with chloramphenicol. There was an immediate improvement in general condition in all the cases, followed by rapid recovery. This somewhat preliminary report is submitted because of (a) the undoubted severity of infection in each case; (b) the dramatic recovery following chloramphenicol ; and (c) lack of the drug to treat a larger series. -
DETAILS OF CASES AND RESULTS
Sp.
not
cyanosed and exhausted from prolonged coughing spasms. His general recovery was well marked 24 hours after chloramphenicol was started, and after the. 3rd day his
boy
Vo. = vomits.
Perforation of a duodenal ulcer 15 months after vagotomy is reported. Only two other cases have been traced and in both of these the perforation occurred within a month of the vagotomy. The remarkable feature of the present case was the lack of rigidity after perforation. Pain, however, was severe, and shock was
profound.
My thanks are due to Mr. Ivor Lewis for permission to publish this case and for his criticism, and to Dr. D. Ferriman who referred the
case
for surgery. REFERENCES
Alvarez, W. C. (1948) Gastro-enterology, 10, 413. British Medical Journal (1948) ii, 652. Johnson, H. D (1948) Brit. med. J. ii, 760. Walters, W., Neibling, H. A., Bradley, W. F., Small, J. T., Wilson, J. W. (1947) Arch. Surg. 55, 151. Weeks, C., Ryan, B. J., Van Hoy, J. M. (1946) J. Amer. med. Ass. 132, 988.
CHLORAMPHENICOL IN WHOOPINGCOUGH REPORT ON 5 SEVERE CASES
JAMES MACRAE M.D. Glasg., F.R.F.P.S., D.P.H. RESIDENT PHYSICIAN, HAM GREEN HOSPITAL, BRISTOL
of small infants with whooping-cough has anxious work. The case-fatality is high under the age of 3 months, and moreover the pulmonary complications of whooping-cough in infancy often remain as a permanent disability and may shorten the patient’s life. When it was reported in July, 1949, that chloram-
THE
care
always been
phenicol
was
active
against Hcemophilus pertussis
in vitro and in experimentally infected animals, a small stock of the drug was obtained and set aside for the treatment of infants with severe whooping-cough. Since then, five infants have been so treated. The cases were selected as being severely ill, with a poor prognosis, but at a relatively early stage of the disease before secondary infections had been added. There was no clinical doubt of the diagnosis, which is sometimes difficult in small infants, and there was clearcut evidence of direct contact with other cases of whooping-cough in every case. The dosage, which was necessarily rather guesswork, was based on a minimum of 50 mg. per kg. of bodyweight daily, with a generous increase in view of the severity of the infection and the low toxicity of the drug. Each baby received 0-25 g. as a first dose and thereafter 0-125 g. 6-hourly for 7 days and 0-125 g. 12-hourly for a further 7 days. It may be that these doses can be reduced as more experience is gained.
Administration of the drug was not difficult. The capsules were opened and the unprotected powder given by mouth in a little black-currant juice (’ Ribena’) by teaspoon some minutes before a feed. It was rather surprising to see this bitter-tasting drug go down so easily. All the infants were nursed in complete isolation throughout the illness. The feeds the baby had been accustomed to before infection were continued, and replacement feeds with, if necessary, replacement doses of chloramphenicol were given to allow for vomiting. Careful records were made of coughing spasms and vomiting. No other drugs were given.
The details of the five cases are summarised in the table. The consistent gains in weight are remarkable considering how ill the infants were at the start of treatment.
accompanying
Case This infant was badly cyanosed on admission and having almost continuous ineffective spasms of coughing intermingled with tiny vomits. She was given oxygen without great effect for 24 hours. Great improvement was noted 12 hours after chloramphenicol was started, and general recovery was complete in 48 hours. Thereafter coughing spasms were short-lived and mild. was
This child’s life was despaired of by her mother and her recovery was regarded as a miracle by the parents. Even the more knowledgeable and disinterested nursing staff regarded the recovery of this first case as very remarkable. Case
2.-Though
=
spasms.
so
severely
ill
as case
1, this little
was
spasms became innocuous. Case 3.-This little boy was as ill as case 1 and his recovery was equally dramatic, being complete in 24 hours. Cases 4 and 5 ran a very similar course. Initially the exhausting, very protracted, coughing spasms were obviously useless and becoming more distressing each time. Some cyanosis was constantly present and the infants had become terrified of
coughing
severely
feeds because they brought on spasms of coughing. After 12 hours of chloramphenicol a remarkable repose was noted, and though coughing continued for a time it was obviously no
longer
a
terrifying experience. SUMMARY
Five infants severely ill with whooping-cough were treated with chloramphenicol. There was an immediate improvement in general condition in all the cases, followed by rapid recovery. This somewhat preliminary report is submitted because of (a) the undoubted severity of infection in each case; (b) the dramatic recovery following chloramphenicol ; and (c) lack of the drug to treat a larger series. -
DETAILS OF CASES AND RESULTS
Sp.
not
cyanosed and exhausted from prolonged coughing spasms. His general recovery was well marked 24 hours after chloramphenicol was started, and after the. 3rd day his
boy
Vo. = vomits.