Antibiotics in Non-Tuberculous Pulmonary Diseases

¹ The Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri.

Penicillin, streptomycin, aureomycin and chloromycetin are all invaluable in the treatment of pulmonary infections.

Penicillin is the drug of choice in all coccal pneumonias, suppurative diseases of the lungs, bronchiectasis, spirochaetal infections and actinomycosis of the lung. It is best given by the intramuscular route, using 50,000 units of crystalline penicillin G every three hours. When repeated injections are not feasable, 12 hourly injections of 400,000 units of penicillin containing 300,000 units of procaine penicillin G and 100,000 units of sodium or potassium penicillin G should be used. In suppurative lung lesions and bronchial infections, aerosol penicillin should be added, using 50,000 units of penicillin dissolved in 1 cc. of saline solution, three times daily, preferably with an oxygen tank. In empyemas, direct daily instillation of 50,000 units of penicillin dissolved in 50 cc. saline into the pleural cavity may be curative.

Streptomycin is the drug of choice in gram-negative infections of the lung. It is highly specific for pneumonias and pulmonary infections due to Friedlander's bacillus, B. tularensis, B. pestis, hemophilus influenzae and E. coli. It is best given by intramuscular injection of gram every six hours until the infection is under control. In suppurative diseases of the lungs and bronchiectasis, aerosol streptomycin in conjunction with penicillin should be used.

Aureomycin is the drug of choice in atypical pneumonia, ornithotic pneumonia, tularemic pneumonia, Rocky Mountain spotted fever, Q fever infections and brucellosis. The drug is given orally, using 1 gram every six hours for several days, and then gram every six hours. Bacterial pneumonias not responding to penicillin and streptomycin may respond to aureomycin.

Chloromycetin is the drug of choice in pulmonary infections due to typhus, salmonella group, E. coli and brucella organisms. The drug is given by mouth, using 1 gram every four to six hours until improvement takes place, then gram every six hours.

Combined Therapy: In pulmonary infections of unknown etiology, it is often invaluable to use both penicillin and streptomycin at once, and if in a short time improvement does not occur, aureomycin and/or streptomycin should be added.

Other Antibiotics: Several of the newer antibiotics show great promise in the treatment of hitherto incurable lesions, such as fungus and viral infections. Most of these are still toxic to animals, but it is very likely that with further refinements in preparation, they will soon prove to be effective in a still wider range of pulmonary infections.