Tuesday, July 15, 2014

Historical Contribution: 1937, Dees and Colston, Sulfanilamide in Gonococcal Infections

Electron micrograph of gonococcus. (from gov.uk)

The use of sulfanilamide in gonococcal infections. Dees JE, Colston,  JAC.   JAMA 1937; 108: 1855.

In 1935, para-aminobenzenesulfonamide (sulfanilamide) emerged as an effective treatment for streptococcal infections.  Subsequent experiments in mice and humans proved that sulfanilamide was an effective treatment for menignococcic infections.  Given that sulfanilamide was proven to be non-toxic at high doses in humans and its clinical efficacy against meningococcus, allowed Drs. Dees and Colston to embark on a clinical trial of sulfanilamide in gonoccocal infections.

In 19 patients, the diagnosis of gonococcal urethritis was confirmed with visualization of cellular diplococci in urethral discharge or centrifuge of collected urine.  In all patients, active urethral discharge disappeared in 1-7 days, with most patients improved within 3 days.  Gonococci were eliminated from the urethral discharge in 2-5 days for the majority of patients -- as did the majority of symptoms.  Some patients did have a slower response to the treatment, and the authors hypothesized this could be due to non-compliance or an abnormality of metabolism of the medication.

They concluded that sulfanilamide was of "great value" and:
This preliminary report is therefore presented for the purpose of stimulating the careful use of this drug in clinics where large numbers of gonococcic infections can be closely followed, so that an accurate evaluation of sulfanilamide in the treatment of gonococcic infections can be determined and the optimum dosage and possible deleterious effects further studied.
This manuscript serves as the first example of sulfa-medications in the treatment of urinary tract infections.

To read the entire manuscript click on the link above or here.

HISTORICAL CONTRIBUTIONS highlight the greatest academic manuscripts from the Brady Urological Institute over the past 100 years.  As the Brady Urological Institute approaches its centennial, we will present a HISTORICAL CONTRIBUTION from each of the past 100 years.  In the most recent experience, the most highly cited article from each year is selected; older manuscripts were selected based on their perceived impact on the field.  We hope you enjoy! 


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