Streptomycin in Tuberculosis

In spite of a tremendous volume of careful work which has contributed largely to our knowledge of the nature of tuberculosis and to elaboration of a treatment regimen that has been productive of great good, the disease has remained persistently resistant to attack. No specific and no cure has yet stood the test of time, although hundreds have been offered. Of these, only one has shown the capacity to influence the disease in man—streptomycin. In January 1944, Schatz, Bugie, and Waksman (1) presented “a new antibacterial substance, designated as streptomycin.” This occasioned little general notice until it was shown, in November of that year (2), that the new antibiotic inhibited the growth of M. tuberculosis. Shortly thereafter Feldman and Hinshaw applied the drug to tuberculous guinea-pigs with favorable results and were able to report its salutary effects on certain types of tuberculosis in human beings (3). These epoch-making observations were followed by intensive experimental and clinical studies and now, for the first time in the history of medicine, a drug is available that exerts a distinctly favorable influence upon tuberculosis in man. Careful clinical observations have been made by various workers, but the drug has been scarce. A few individual investigators, the Veterans Administration and the Army and Navy (4), the United States Public Health Service (5), and the Therapy Committee of the American Trudeau Society (6) have, altogether, studied the effects of the drug in about 2,000 patients, with results which suggest the following deductions: (1) Streptomycin should be tried in all cases of miliary tuberculosis, for more than half of such patients will be alive, and a substantial number of them will be free from clinical, x-ray, or laboratory signs of disease, six to twelve months after discontinuation of the drug. (2) The use of the drug in tuberculous meningitis is mandatory, for about onefourth of all patients have survived from six to twelve months after treatment, and the majority of these are free from detectable signs of tuberculosis. (3) Acute tuberculous pneumonia or exudative (fresh) tuberculous disease of the lungs will usually show recession, with notable clearing of the lungs demonstrable roentgenographically within a few weeks. Tubercle bacilli disappear from the sputum in about half these cases. Such patients however, needstillfurther sanatorium care. (4) Extrapulmonary tuberculosis is under detailed study, but already it appears that tuberculous laryngitis and bronchitis are benefited by the use of streptomycin in about 85 per cent of cases, even though the parent lesion in the lungs may show no improvement. Tuberculous enteritis and cystitis likewise tend to improve. In fact, in areas in which the disease affects the epithelial surfaces, results are generally good. Cutaneous sinuses do well. Tuberculosis of the osseous and genito-urinary systems needs further study.