The status of streptomycin and dihydrostreptomycin in the treatment of leprosy

ABSTRACT

Evidence is given by this study that, in dosage as lown as 0.5 gm. daily, streptomycin and dihydrostreptomycin produce beneficial efffects upon the specific cutaneous and mucous membrane lesions of leprosy. These beneficial effects may appear earlier in treatment than similar improvement obtained by the use of promin and diasone, and they are sustained as long as the drugs are administered. Advanced eye involvement is resistant to streptomycin treatment, as it is to the sulfones, but the symptoms associated with these antibiotics. Iridocyclitis appearing during sulfone therapy also often responds to this treatment. Little, if any, beneficial effects is exerted on acute lepra reactions, or on such complications as acute lymphadenitis, orchitis, neuritis, edema of the mucous membranes or skin associated with such reactions. The appearance of toxic manifestations, vertigo, tinnitus, and loss of hearing usually precludes the continuos administration of these drugs beyond a period of six months, and rarely will a patient tolerate them for more than one year. Although clinical improvement at the end of such periods of treatment is marked, the concentration of bacilli in the remaining skin lesions, as reported by the laboratory, remain unaltered. Since a material portion of the volume of a leproma is composed of bacilli in the tissue. If that were not so the numbers of bacilli in the smears would increase correspondingly with decrease of the tissue elements in the lesions. In these two respects treatment with these antibiotics parallel those obained with the sulfones. The sulfones, however, can be administered indefinitely and usually a definite reduction of bacilli in nodular lepromatous lesions as reported by the laboratory, can be demostrated after an average of two or three years of treatment. When, if ever, such a reduction can be effected by streptomycin therapy alone cannot be determined unless a much less toxic product can be created or the dose and frequency of injections can be further reduced to a nontoxic level without a loss of therapeutic activity. The early response of mucous membrane lesions to these antibiotics, with relief from annoying symptoms, is undoubtedly due to the elimination of secondary invaders, including saprophytic organisms growing in and upon leprous lesions of the nasal, pharyngeal, and laryngeal mucous membranes...