Association of aureomycin used by intramuscular route and of chloromycetin by oral administration in the treatment of rocky mountain spotted fever: Consideration on the results obtained from the use of purified aureomycin by parenteral injection

Abstract

Having verified by a great number of cases of Rocky Mountain Spotted Fever that the treatment can only be of benefit to a limited number of patients, because of the fact that it is only started rather late, the authors think that the therapeutic problem rests on the rapidity with which the disease has to be fought. In fact, the patients enter the hospital, in general, on the ninth day of the disease, and the death occurs generally on the second week of the disease. Thus they advise the association of the parenteral to the enteral route in the administration of the antibiotics. The inconveniences caused by the injection of Aureomycin, such as: irritation, intense local pain, inflammation and necrosis were removed by the method introduced by J. J. Macedo, O. Haberbeck Brandão and E. Lemos Monteiro who succeeded in using the antibiotic produced for oral administration as subcutaneous injections without the occurrence of the mentioned reactions. In a series of experiences carried on by the authors in the Instituto Butantan, São Paulo, Brazil, they verified that the guinea-pigs infected by Dermacentroxenus Rickettsi, when receiving simultaneously the injection of a solution of purified Aureomycin, in a sufficiently large dosis, were not infected; if the dosis were insufficient, the disease was delayed in its development. In experimentally infected animals, the Aureomycin, injected subcutaneously, was capable of producing the cure, within 12 and 24 hours, in dosis of 2 to 20mg per kilogram weight. With such experimental results, agreeing in a large series of animals, they used the purified Aureomycin in a patient deeply ill, comming from the rural zone, 13 years old, white, weighing 39 kilograms, admitted on the 8th day of the disease. The patient was highly intoxicated, with delirium, showing generalized exanthem on the body, presenting on some of the regions true ecchymosis. At the beginning there were given 6 capsules of 250mg of Chloromycetin, followed by 1 capsule each 3 hours, Twenty two hours afterwards, when there had been given already 3,0 g of this antibiotic, without any change in the clinical picture or on the temperature, an intramuscular injection of 60mg of Aureomycin was given, in a solution of 1% of Novocaine. The temperature was then 40,1°C. This dosis was perfectly well tolerated. That was the situation in the afternoon. The next morning the temperature declined to 38° and at noon to 37,4°. The general condition had apparently improved. Twenty four hours after the first injection, another one of 100mg of Aureomycin was given. The temperature had risen to 38,2°. At midnight the temperature reached 38,8°, and then on the following morning fell to 37,2° and at noon to 36,6°. On the afternoon of that day, another injection of 60mg of Aureomycin was given. Since then the temperature did not get over 37,5° at night. On the next day another intramuscular injection of 60mg of Aureomycin was given. The patient continued taking by mouth, each 3 hours, 1 capsule of Chloromycetin. After the administration of the second injection the general condition improved considerably, the pulse having followed in perfect harmony the thermic variations. The punctiform exanthem and the smaller macules disappeared after the 4th or 5th day of treatment, and the eruption due to the ecchymosis persisted for a long time, and finally desquamated. The authors, based on the experimental works mentioned above and on what was observed in this patient, believe that the injection of Aureomycin led to the rapid improvement and the cure of this patient. For that reason, they compared this case with that of another patient, of almost the same age, the disease lasting the same number of days and of identical gravity, treated only with oral Aureomycin, who died 42 hours after the treatment was started (total dosis:7,0g). If the success of this first observation be confirmed, the authors believe that both the use of the parenteral route as well as this one associated to the enteral route will be of great success in the future, not only in the treatment of the Rocky Mountain Spotted Fever, but also, probably, in the typhoid fever and in other diseases for which the use of these antibiotics has proved to be of good results.