Dr. Boger obtained his data by examining blood and CSF samples from patients admitted for institutional care after single oral doses of the tested sulfonamide had been given. If there were cells in the CSF, or it were in any other way abnormal, it was discarded.
Whatever the reasons for the different absolute quantities reported by these several competent observers, one thing should be clear. The blood level of an antibiotic does not necessarily indicate what its biological activity will be. Phenethicillin, for example, is absorbed in greater concentrations than benzyl penicillin G, yet is less effective against group A streptococci or pneumococci.1 Weinstein and Samet2 have shown that there is no correlation between the degree of antibacterial action and the plasma concentration of either triple sulfapyrimidines or sulfadiazine alone.
Dr. Maren's interpretation of Dr. Boger's paper is accurate, and the conclusion that the trisulfapyrimidines are useful in
Meade RH. Sulfonamides in Treatment of Meningococcal Meningitis-Reply. JAMA. 1964;187(9):682. doi:10.1001/jama.1964.03060220056024