Streptomycin in the Treatment of Miliary and Meningeal Tuberculosis Based on a Study of 30 Cases

¹ Chief, Tuberculosis Service.
² Assistant Chief, Tuberculosis Service.
³ Consultant in Tuberculosis.
⁴ Attending Physician in Tuberculosis.
⁵ Physician, Streptomycin Research Section.

1) Streptomycin seems effective in the treatment of uncomplicated cases of miliary tuberculosis. This could be accounted for by the small size of the individual tubercle which may permit the drug to readily penetrate throughout the lesion in therapeutic concentration and to come in direct contact with all the organisms, a condition which probably does not exist where larger areas of caseation are present.

2) Streptomycin did not prevent the development of tuberculous meningitis in patients while they were under treatment with the same drug for other tuberculous conditions.

3) It seems possible that the main obstacles to successful therapy of tuberculous meningitis may be: (a) a factor in the brain, presumably, yet unidentified, which has the property of inhibiting streptomycin and thus rendering it ineffective; and (b) the relative inability of streptomycin to penetrate the larger caseous foci.

4) Until a more effective antibacterial agent against tuberculosis may be discovered, efforts will undoubtedly be continued to identify the streptomycin inhibiting factor in the brain, and to find means of combating it. Further search is also indicated for some means of more effectively carrying the therapeutic agent into the caseous masses.

5) Our experiences thus far lead us to believe that higher doses of streptomycin would probably not materially improve the results in tuberculous meningitis and in combined miliary and meningeal tuberculosis. It does not seem likely that the streptomycin inhibiting factor in the brain and the conditions which seem to prevent the drug from entering the caseo-necrotic mass in therapeutic concentration, could be overcome with relative safety by sheer volume of this antibiotic.