The extraordinary success of sulfanilamide in the treatment of streptococccic otogenic meningitis has led to the widespread use of the drug in all cases of otitic infection in which the beta-hemolytic streptococcus can be identified. Such enthusiasm for specific chemotherapy is readily understood but is open to considerable criticism. The patient with meningitis is under hospital observation, and treatment is continued until the spinal fluid has returned to normal. The patient with acute otitis media or mastoiditis receives sulfanilamide only as long as there is persistent pain or discharge, and treatment is usually stopped on clinical instead of laboratory evidence.
It has been shown that the sulfanilamide treated animal survivors of hemolytic streptococcus infection fail to acquire protective antibodies as a result of their experience.1 Lyons2 has demonstrated that sulfanilamide induces an attenuation of the virulence of hemolytic streptococci and that the organisms regain their virulence on subcultivation
CONVERSE JM. RECURRENCE OF OTITIC INFECTIONS DUE TO THE BETA-HEMOLYTIC STREPTOCOCCUS: FOLLOWING INADEQUATE SULFANILAMIDE THERAPY. JAMA. 1939;113(15):1383–1387. doi:10.1001/jama.1939.02800400011004
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