Streptomycin in tuberculosis

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      Streptomycin is the most effective antibacterial agent known for tuberculosis. In vitro it has a marked bacteriostatic action on the tubercle bacillus, and in vivo it tends to exert a deterrent effect on the disease in both animals and man. Its therapeutic value is limited by the fact that after exposure to streptomycin for weeks or months, strains of Mycobacterium tuberculosis which are resistant to the effects of the drug may be isolated. Hence streptomycin is of most value in conditions in which temporary suppression of the infection will enable the patient to gain the ascendency over his disease; healing then occurs by natural processes.
      Prolonged arrest of the disease has been achieved by treatment with streptomycin even in cases of hematogenic tuberculosis, including generalized miliary tuberculosis and tuberculous meningitis. For these conditions large doses of streptomycin must be given parenterally for several months, and for meningitis intrathecal injections are imperative also during the early weeks of treatment. Other types of tuberculosis which have responded to treatment with streptomycin include exudative pulmonary disease, ulcerating lesions of the respiratory tract and tuberculous draining sinuses. It has some place in the treatment of bilateral renal tuberculosis or tuberculosis of a solitary kidney. It also is used before and after thoracic surgery for pulmonary tuberculosis. Because of the potential toxicity, use of the drug probably is contraindicated in conditions which will respond satisfactorily to the usual methods of treatment.
      Our knowledge of streptomycin is still in a state of flux. Now that the drug is undergoing extensive clinical investigation in many institutions its ultimate place in the treatment of tuberculosis will be determined in time. Experience with this antibiotic agent has proved that tuberculosis is a disease amenable to antibacterial therapy and it is hoped that other usable agents will be forthcoming.
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