Calcification of the Peritoneum

Abstract

Nov. 3, 1951 CHLORAMPHENICOL IN STAPHYLOCOCCAL MENINGITIS BrDIcrms 1069 the patient was symptomless and was, in fact, making persistent demands for permission to' get up. Intrathecal chloramphenicol was discontinued after six days, and oral therapy after 12 days. The results of three assays performed on the lumbar fluid are shown in the Table. The patient maintained uninterrupted progress and was allowed to get up. DiscussionIt is difficult to explain why Case 1 developed meningitis while receiving full doses of aureomycin by mouth. The infecting organism was shown to be markedly sensitive, and the isolated assay performed while the patient was still taking the drug suggested an adequate concentration to be present in the cerebrospinal fluid. Two possible explanations present themselves. First, it seems likely that the cerebrospinal fluid was subjected to repeated and heavy contamination from the collection of infected fluid deep to the operation flap. This is sufpported by the findings of numerous cocci in Gram films prepared from several samples of fluid, and also by the isolated positive culture and cell peaks seen in Fig. 1 SummaryTwo cases of staphylococcal meningitis resistant to penicillin and streptomycin are described.Possible reasons for failure to control the infection with aureomycin in Case 1 are examined, and the methods and results of treatment with intrathecal chloramphenicol are discussed.We are indebted to Mr. Murray Falconer for permission to publish the details of these cases, and to Professor R. Knox for advice and encouragement during the bacteriological investigations. Our thanks are also due to the Department of Clinical Pathology, Guy's Hospital, for giving us details of the cell counts and protein estimations on the fluids, and for their co-operation in other ways; also to Parke, Davis and Co., Middlesex, for supplies of crystalline chloramphenicol.ADDENDUM.-Since the preparation of our .paper, chloramphenicol has been introduced into the lumbar theca in doses as high as 3 mg. without undesirable results. Where intrathecal therapy has been continued for-a week or more, two side-effects have been noted in patients so treated.1. Depression with tearfulness has been seen in all patients. Some have occasionally responded to lumbar puncture and clinical examination with outbursts of weeping.2. Where a cerebellar tremor has been present due to a pre-existing lesion or to operative interference, this tremor has been markedly accentuated by intrathecal chloramphenicol.Both these side-effects hlave disappeared with the cessation of intrathecal therapy.