Thrombocyte Deficit

Abstract

the lowest age group was poorly represented, there being only 33 patients under 10 years of age in the entire study. COMMENT Although the sulfonamides have been used exten¬ sively for several years and nearly every physician has had some experience with them, nevertheless there is no common agreement as to the seriousness of their toxic effects. It is the common practice of many physicians to use them in a great variety of diseases, even when the indications for their use are not specific (or, indeed, very clear), since these drugs have, as they say, prac¬ tically no toxic effects. On the other hand, many physicians, particularly those who have seen fatalities attributable to these drugs, believe that they may cause serious or fatal complications even under the most careful regulation of treatment and observation of the patient. We believe that the figures which we have presented do not support either of these extreme views. We have shown that toxic reactions occur following the use of sulfapyridine, sulfathiazole and sulfadiazine, in descending order of frequency, but that the serious complications are few in number when the patients are watched closely, when the drugs are stopped promptly if reactions occur, and especially when sulfadiazine is used. Only 3 patients in the entire group died at a time when a complication of sulfonamide therapy was present. In 2 of these who had renal calculi the deaths were unquestionably due to the diseases for which the sulfonamides were being given. In the third patient, who developed acute hemolytic anemia in the course of sulfapyridine therapy for pneumonia, death may have been contributed to by the drug reaction. Thus it is seen that 1,564 courses (including second and later courses) of the sulfonamides were administered to a large group of patients, for the most part under the conditions which exist in a city hospital, with a mini¬ mum of serious toxic reactions and only one fatality which might have been due in part to the sulfonamide administered.The question of how best to avoid toxic reactions is best answered in two parts. First, renal calculi may be avoided by the use of sulfadiazine in preference to sulfathiazole and sulfapyridine, and by preserving the proper balance between the amounts of drug and fluids given. When good results can be expected from the treatment of a disease with relatively small doses of a sulfonamide, as we have shown to be the case with sulfadiazine in pneumococcic pneumonia, this method of avoiding renal calculi should be taken. When larger doses are needed they can be used without the formation of calculi if careful attention is paid to fluid intake and output.Secondly, with regard to other complications, vomit¬ ing is almost completely absent when sulfadiazine is used, while the chances of producing drug fever, der¬ matitis, anemia and leukopenia following sulfadiazine therapy are either the same as or less than if other sulfonamides are used. Even with sulfadiazine a few toxic reactions of this sort will nevertheless occur.Serious and f...