Postgrad Med J: first published as 10.1136/pgmj.40.Suppl.139 on 1 December 1964. Downloaded from 139 Staphylococcal strains resistant to oxacillin sensitive to penicillin G, 16 did not react to or cloxacillin were not encountered. Past oxacillin and four did not react to cloxacillin. experience with methicillin, as well as with However, hypersensitivity to penicillin G is other antibiotics, has shown that resistant sometimes not seen during 'a repeat course, strains occasionally develop following pro- so that the absence of such symptoms, when longed and injudicious use of these agents. It oxacillin, given after a previous course of is possible that the same situ!ation may arise penicillin G had produced a hypersensitivity with oxacillin or cloxacillin, although so far reaction, does not always indicate that the no post-therapy-resistant strains have been patient was hypersensitive to penicillin G and reported. The useful life of these drugs will not to oxacillin. be extended by avoidance of routine prophy- Minimal requirements of therapy are early lactic use and inadequate dosage forms and by recognition and bacteriological diagnosis, employing appropriate surgical management prompt and adequate antibiotic therapy with of the infection, including adequate drainage, an effective agent, and surgical control of the debridement, removal of foreign bodies, etc. primary foci of infection by drainage, debride- In a few patients gastrointestinal side effects ment and removal of foreign bodies. ensued with the larger doses of oral oxacillin and nafcillin but not as yet with cloxacillin. Characteristic REFERENCES "penicillin" type of rash was BUNN, P. A., and MILICICH, S. (1963): Antimicrobial also observed with all of the new penicillins Agents and Chemotherapy, Amer. Soc. Micro- and therefore, all new semisynthetic penicillins biol., p. 220. should be administered with care to patients GRAVENKEMPER, C. F., SWEEDLER, D. R., BRODIE, with a history of allergy to penicillin G. On J. L., SIDELL, S., and KiRBY, W. M. M. (1963): Antimicrobial Agents and Chemotherapy, Amer. Protected by copyright. the other hand, of 20 patients previously Soc. Microbiol., p. 231.

DISCUSSION H. A. VAN GEUNS (The Hague, Holland). I would like to report some results from two enough to be treated by our special team. All clinical trials which my colleague Dr. Kerrebijn the children were first examined by the E.N.T. and I were running at an out-patient clinic for specialist, and were vaccinated with influenza asthmatic children in Queen Juliana's Child- virus vaccine. ren's Hospital in the Hague during the 1962/63 and 1963/64 winters. The patients were distributed at random over Apart from children with three groups of similar age and comparable simple asthmatic http://pmj.bmj.com/ attacks we see many children with recurrent living conditions. The prophylactic treatment bronchial infections especially during the winter was given each morning before 'breakfast. months. Group one consisted of 24 children taking In Holland it is a widely used practice to propicillin (125 mgms.), Group two, 26 child- protect such children during the winter months ren taking sulphadimidine (500 mgms.), and by continuous administration of sulphonamides. Group three 25 children taking a placebo (one However, we found that about one third of all tablet each morning). The experiment was the pneumococci isolated from such patients organised on a double-blind basis. Every child on September 28, 2021 by guest. proved to be resistant to sullphonamides, and was examined at least once a month. this 'has been confirmed by other Dutch invest- The results of the prophylactic treatment igators. were judged mainly from the number and In our first trial 75 children were studied, severity of the respiratory infections developed their ages ranging from four to twelve years. by the children. Infection was judged on the They had all suffered for at least a year from basis of the findings in the sputum, X-ray recurrent infections of the lower respiratory examination and 'physical examination. A tract with an allergic basis. The children con- secondary criterion was the general impression cerned are all selected cases as we accepted only gained by the parents of the child's condition in those patients referred from the general out- the period of treatment as compared to that patient clinic which were judged to be serious in the previous year or years. Postgrad Med J: first published as 10.1136/pgmj.40.Suppl.139 on 1 December 1964. Downloaded from 140 TABLE I TABLE II A Comparison of Propicillin and Sulphadimidine in A Comparison of Tetracycline and Phenethicillin in the Prophylaxis of Recurrent Bronchial Infection. the Prophylaxis of Recurrent Bronchial Infection. Effective Dubious Failure Total Effective Dubious Failure Total Propicillin 14(58%) 8(33j%) 2(8+%) 24 Tetracycline 13(43%) 7(23%) 10(34%) 30 Sulfadimidine 8(30%) 10(40%) 8(30%Y) 26 Phenethicillin 17(62%) 6(20%) 6(18%) 29 Placebo 4(16%) 15(60%) 6(24%) 25 ing 14 mgm. of tetracycline per kilogram of Table I shows that during this trial over body weight in two dividend doses. In the half the children treated with propicillin had second group the patients received 10-14 mgms. few or no complaints, and that less than of phenethicillin per kilogram of body weight 10% had numerous infections. There was no in two dividend doses. significant difference between the results ob- The results of this trial are shown in Table II. tained in the sulphonamide and placebo groups. This shows that phenethicillin produced about The large number of cases falling into the the same result as tetracycline. In 62% of the "dubious" group is due to the difficulty in children recurrent infection was effectively con- obtaining sputum from children to confirm a trolled with phenethicillin, compared to 43% diagnosis of bacterial infection. Whenever there effectively controlled by tetracycline. The results was the slightest doubt about an infection the of propicillin in the previous trial and phene- treatment was considered ineffective and the thicillin in the second trial are almost identical. judgement of the progress of the case was The conclusions we have drawn are firstly changed into "dubious". It was concluded that that sulphonamides are of no great value Protected by copyright. in the results achieved with propicillin were better preventing bronchial infections in the "chesty than the results with the two other forms of child". Secondly that the oral penicillins tested treatment. give good results in about 50-60% of rather In our second double blind trial during the severe cases and thirdly that there is little differ- following winter we studied two groups of ence found between penicillin and tetracycline children. The patients in the first group receiv- in these cases in the doses we have used. http://pmj.bmj.com/ on September 28, 2021 by guest.