With the introduction of streptomycin in the treatment of clinical tuberculosis in 1945 by Hinshaw and Feldman1 there was hope, on the basis of experiments with animals, that this antibiotic would cause definite arrest or cure of pulmonary tuberculosis. It was not long before it became evident that in the type of tuberculosis most commonly seen in sanatoriums and hospitals, advanced tuberculosis with cavitation, treatment with streptomycin seemed to have at best only a temporary effect. It was noted that exudative tuberculosis would resolve and that early infiltrate might disappear, but that in general cavities remained and that the sputum cultures remained positive.2 Fibrous elements in the lung, whether associated with cavities or not, were untouched by this drug.
The pathologic and physiologic aspects of the tuberculous lesion explain this type of reaction. Streptomycin reaches the diseased organs through the blood stream, and any lesion well supplied with
LEVINE ER, KLEIN WS, FROMAN A. STREPTOMYCIN AS ADJUNCT IN TREATMENT OF ACUTE PULMONARY TUBERCULOSIS. JAMA. 1948;138(11):808–813. doi:10.1001/jama.1948.02900110018006
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