The Treatment of Pulmonary Infections with Sulfanilamide, Sulfapyridine, and Sulfathiazole

¹ Baltimore, Maryland

(1) The sulfonamide drugs—sulfanilamide, sulfapyridine, and sulfathiazole—have been shown to be extremely valuable in the treatment of many types of pulmonary infections.

(2) The drug of choice in an individual case depends upon the etiology of the infection.

(3) In pneumonia or empyema due to the beta hemolytic streptococcus, sulfanilamide is the drug to be recommended. In lobar pneumonia and other pneumococcal infections, sulfapyridine has proven most effective, whereas for staphylococcal infections of the lungs and bloodstream sulfathiazole appears to be the most potent therapeutic agent available.

(4) The introduction of sulfapyridine therapy has resulted in a reduction in the case fatality rate of lobar pneumonia to below 10 per cent. About two-thirds of the pneumonia patients who would formerly have succumbed to their infection may now be expected to recover.

(5) Type-specific antipneumococcal serum should be administered in conjunction with sulfapyridine to all patients seriously ill with lobar pneumonia, especially if bacteremia be present, and in all severe cases of pneumonia complicating pregnancy.

(6) Sulfathiazole appears to be about as effective as sulfapyridine in the treatment of pneumococcal lobar pneumonia. The questionable slight therapeutic inferiority of sulfathiazole is more than balanced by the fact that this drug is much less likely to give rise to severe nausea and vomiting.

(7) Sulfapyridine or sulfathiazole is indicated in bronchopneumonia, post-operative pneumonia, and severe purulent bronchitis, particularly if a pneumococcus or staphylococcus be the causative agent.

(8) Sulfanilamide, sulfapyridine, and sulfathiazole all give rise to a variety of toxic effects, the most serious of which concern the hematopoietic system, and the urinary tract. Because of the danger of such toxic effects the patient receiving one or another of these drugs should be carefully supervised throughout the course of treatment. Such supervision should include observation of the patient by the physician, accurate recording of the temperature and pulse, determination of the hemoglobin level and leucocyte count at least every other day, and frequent urinalyses.