1.5 Topical Neomycin in Cervical and Viginal Infections With Special Reference to Bacillus Proteu

8/10/2019 1.5 Topical Neomycin in Cervical and Viginal Infections With Special Reference to Bacillus Proteu

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14

S.A. M ED IC AL JO UR NA L

1 January 1955

TOPIC L NEOMYCIN IN CERVIC L N . V GIN L INFECTIONS WIT

SPECI L REFERENCE TO CILLUS PROTEUS INFECTIONS

WERNER

WEINBERG,

M R RCH RAND , M D BERLIN

Johannesburg

Antibiotics has been a

boon

in the treatment

of

cervical

and

vaginal infections, especially

in

their relation to

sterility. Even chronic cases have reacted surprisingly

well to antibiotic therapy and the question of topical

applications directly to the cervix and intracervically

has been discussed by the

author

before.

I

, 2 Aureomycin,

crysticillin, streptomycin

and

sulphonamides have been

used for this purpose

in

the form of ointments or

solutions.

The

oral

and

parenteral use of antibiotics

guided by sensitivity tests yielded good results,

but

their

topical use has not been very successful, especially in

chronic cases and in particular in bacillus proteus

infections.

It is a well-known fact that R proteus in the cervix

and vagina is extremely resistant to treatment.

In

bladder infections intramuscular streptomycin has

proved successful,

but

in cervical and vaginal lesions

neither streptomycin nor other antibiotics or chemo

therapeutic agents have been of any distinct value.

Frequently proteus is not found

in

the original vaginal

and cervical culture, but appears only after the dis

appearance

of the primary bacillary infection, particularly

haemolytic streptococci and staphylococci. Seeing

that

many of the oral antibiotics cause a slight diarrhoea, may

it be possible that they predispose to the appearance

of

the proteus,

or

does this scavenger

appear

only after the

primary pathogens of cervix and vagina have been

destroyed?

The

spermicidal tendencies of

Escherichia coli,

Streptococcus viridans,

haemolytic streptococci, staphylo

cocci and

Proteus vulgaris

are well known.

2

, 3

I

advocated

the

combination of oral

or

parenteral anti

biotic treatment with local antibiotic intracervical

and

vaginal therapy

in

order to obtain the best results in

cases of infection and found it therefore of interest to

investigate the efficacy of neomycin-sulfate cream

Myciguent Cream ; which was kindly put at my disposal.

T M nil

T M ni l

T nil

yes

C

nil

T EC, BP

nil

SM StaAuH n

BP

T StaAuNH StaAuNH

T M M

yes

yes

yes

yes

yes

yes

yes

yes

yes

Pregnant

after

treatment

nil

nil

M

nil

nil

nil

nil

nil

ni l

BP

nd

bacterial

flora

after

treatment

nil

StaAuH nil

T

nil

nil

nil

M

BP

nil

T

BP

Str

BP,

T

BP

nil

BP

M

StaAuH nil

StaAuNH

StrNH nil

BP

nil

nil

BP ni l

BP

BP

1st

bacterial

flora

after

treatment

StrV

BP

nil

nil

T nil

SM

SM

C

T

T

SM

T

C

T

C

T

T

E

T

T

T

C nil

T

SM

T

T

T

E

T

T

nti

biotic

used

TABLE [

continued

7 EC, BP

8

BP

9

BGNH

StrNH

IO EC,

BD

StaAuH

BP

EC, BP

12 StrH

StaAuH

BD

13

BP

14 L, StrH

15 StaAuH

BD

16

BP

StaAuNH

17

StrH

18 StaAuH

T

19 StaAuH

StrV,

BD

StrH

20 StrNH

StaAuH

BD,T

21

T, BP

StaAlb

22

StaR, BD

23

StrH

StrNH

24

StaAuH

25 StrH,

BC

StaAuH

26 StaAu

27

StaAu

BD,

M

28 BC, M

29

StaAuH

BD

30 StrH, BD

31

StrNH

Sta H

32 StaAuH

BD

33 StaAuH

34

StrH

35

StaAu

T

36

StrV

BD, BP

37

StaAuH

BD

38

StaAu

St r H

BD

39 StaAuH

BP

40

EC,

BP

Number

of Bacterial

cases infection

yes

yes

yes

Pregnant

after

treatment

nil

nil

nil

2nd

bacterial

flora

after

treatment

nil

nil

M

St r H

StrV

BP

StrV.

StaAlb

BP

StrV

BP

1st

bacterial

flora

after

treatment

nil

TABLE I

T.

T.

T.

T

T.

T.

nt i

biotic

used

5 StaAuH

BD

StaAuH

BD,

BP

2 BC,BP

3 StaAuH

StaNH

BD.

4 StaAuH

StrV.

6

StrH

BP

Number

of Bacterial

cases infection


2/3

BP

nil

15

Streptomycin.

Terramycin.

SM

T

Haemolytic Staphylococcus aureus.

on-haemolytic Staphylococcus aureus.

Haemolytic Staphylococcus.

on-haemolytic Staphylococcus.

Haemolytic Streptococcus.

on-haemolytic Streptococcus.

Streptococcus viridans.

Trichomonas.

Crysticillin.

Erythromycin.

StaAuH . .

StaAuNH

StaH

StaNH

StrH

Str H

StrV

T

Drugs:

C

E

Mrs. H.S. was trying to have

an

inf ant f or 9 years an d was

suffering from cervical an d vaginal.bacterial infection with hae

molytic Staphylococcus aureus an d Streptococcus viridans. Oral

tre atme nt with 48 c apsule s Ter ra mycin m gm 250 ove r 8 days

an d

daily intracervical

and

vaginal topical application

of

neomycin

c re am was institute d: The second bacteriological examination

carried ou t

8

days after therapy was commenced showed monilia,

non-haemolytic streptococcus, Streptococcus viridans and Pro-

teus vulgaris.

Th e patient was then treated daily

for 10

days with

topical application of neomycin alone; the third bacteriological

examination showed

no

pathological organisms

an d

within

3

weeks from the beginning of treatment the patient pregnant.

In most cases th e second bacteri610gical examination

was done within 8 days

of

the institution

of

therapy and

if

the necessity arose a third one within 3 weeks from the

beginning

of

treatment.

No

side-effects have been observed f ro m t he use

of

topical neomycin. Neomycin did no t affect trichomonads

or

monilia.

Th e

most interesting finding was the almost specific

effect on

Proteus vulgaris.

Th e incidence

of

this organism

an d

the effects

of

treatment are shown

in

Tables

II

and

Ill.

Table I tabulates results

in 7

cases

of

cervical an d

vaginal infection. In all cases or al or parenteral anti

biotic treatment has been combined with repeated

topical intracervical and vaginal application

of

neomycin

sulfate cream.

The

general and topical use

of

antibiotics

i n the tre atme nt

of

cervical

an d

vaginal infection ha d

considerably improved the likelihood

of

cure, bu t the

topical use of neomycin combined with oral or parenteral

antibiotics has further increased the percentage

of

cure.

In a previous communication 2 prior

to the

intro

duction

of

topical neomycin) I was able

t o r ep or t t ha t

in

34 cases

of

cervical and vaginal infection pregnancy

resulted in

12

cases 34

after treatment by the general

and topical use

of antibiotics . Af ter t he combi ned use

of

antibiotics and topical neomycin pregnancy resulted

in

31

out

of 7

cases treated i.e. 44.5

.

This

is

a cons iderabl e i mpr ovement, especially as

cases

of

very long standing responded surprisingly well.

I would like to quot e case 4:

V I R G EN E E S K UN DE

yes

yes

yes

Pregnant

after

treatment

nil

nil

nil

nil

nil

M

T

yes

nil

ye-s

M yes

yes

ye-s

yes

yes

yes

nil yes

nil yes

nil yes

nil yes

yes

nil yes

TYDSKRIF

2nd

bacterial

flora

after

treatment

T nil

T BP

C nil

T nil

T nil

T

StrH

StaAlb

BP

E nil

SM BP

C BP

T M

T T BP

T

nil

T BP

T nil

T nil

T nil

C M

T

BP

T

BP

SM StaAuH

M

T

BP

T

BP

T

BP

T nil

T BP

S

T nil

T nil

T

BP

T nil

1st

n ti bacterial

biotic flora

used after

treatment

T nil

TABLE I

continued

41 StaAu

BD

4

StrV

StaAuH

BD

43 StaAu, M

44 StaAuH

StaAu H .

45

StrV

StrH

46 BP

StaAuH

47 StaAuH

StaNH

BD

48 BG N

49 EC , BP

50

StaAuNH

BD

51 T, StrH

52 T, StrH

StaAlb

BD

53 StaAuH

BD

StaAuNH

54 StrH

StaAuH

StaAuNH

55

EC , BP

56 StaAuH

BD, BP

57 StrNH

StrV, BD

58 StaAu

T,

BD

9 StrV,

T, BD

60

StaAu

BD

61 EC, BD

StaAu

62

StrV,

BD

StrNH

63 StaAu,

BP

64 StrH

StaAu

65 StaAu,

T BP

66

StrNH

BD

67 StaAuH

BP,

BD

68 T,

StaAuH

69

StaAlb, T

70 StaAu,

BP

Number

o

Bacterial

cases infection

Januarie 1955

TABLE

II.

INCIDENCE OF BACILLUS PROTEUS

Bacillus proteus present Cases

In

mixed bacterial infections before treatment . .

21

I n the first bacterial flora after treatment 28

Fo r th e

first time in the bacterial flora af ter

treatment

17

Persisting in t he second bac t erial flora aft er

treatment 2

Bacteria:

BC

BD ..

BG N

BGNH

BP ..

EC

L

M

StaAlb

StaAu

Coliform bacillus.

Diphtheroid bacillus.

Gram-negative bacillus.

Haemolytic gram-negative bacillus.

Bacillus proteus.

Escherichia coli.

Leptothrix.

Monilia.

Staphylococcus albus.

Staphylococcus aureus.

Total . .

38


3/3

16

S M E D IC L J O UR N L

1

January

1955

TABLE I II. RESULTS

OF

TREATMENT

Bacillus proteus present Cases

Responding

to

initial

treatment

with anti -

biotics and topical neomycin . . 10

Responding

to

topic al neomycin a pplica tion

alone 26

Resistant

to

topical neomycin 2

Total

38

Thus the proteus infection was eradicated in

36

out .

of 38 cases.

Of the 38 cases of p ro te us i nf ec tio n t rea te d w it h

antibiotics and topical neomycin

18

resulted in preg

nancy.

I attribute these excellent results

to

the application of

topical neomycin and I recommend its use in proteus

infections.

SUMMARY

1 Seventy cases of cervical

and

vaginal infection, of

which 31 resulted in pregnancy, have been presented.

2

All these cases have b ee n t re at ed with

the

appro-

priate antibiotics

in combination

with topical neomycin.

3.

Amongst these

70

cases t he re were

38

cases of

infection with Proteus vulgaris

4. Ten cases of proteus infection responded

to

initial

treatment with antibiotics and topical neomycin and

26 to the use of topical neomycin alone; i.e. over 90

of

cures.

5. Of 38 cases

of

proteus infection 18 cases resulted in

pregnancy after treatment.

6 The use of topical neomycin alone or in combina

tion

with other antibiotics is of distinct value in cervical

and vaginal infection, especially when bacillus proteus

is present.

am

grateful

to Dr.

Harold R. R eam es , P h. D: , M.D.

Medical Division

Department of

Clinical Investigations, The

Upjohn Co mp an y, Ka la rna zoo , Michigan, who su ppl ied t he

neomycin-sulfate cream Myciguent Cream).

My special thanks are furthermore

due to

Dr . W. Lewin,

Patho-

logist, Johannesburg, for the bacteriological work.

REFERENCES

1.

W ei nb er g, W. 1948): S. A fr . M ed . J ., 2 2, 5.

2 Idem 1953): Ibid 27, 1032.

3. Mat th ews , C. S. and Buxton, C. L 1951): Fertil. and Steril.,

2,45.

R VISION S RI S

V.

TH M N G M NT OF M L RI

MICHAEL GELFAND.

G E M.D. CAPE

ToWN),

F.R.C.P.

D.P.H.

Physician Salisbury Native Hospital

Too muc h emp hasis has p er ha ps b een placed on what

constitutes the dosage of an anti-malarial drug, since

most assessments refer

to

cases of average severity.

Any such estimation, especially

in

a disease like malaria,

tends to overlook the clinical condition

of

the patient.

O ne c an no t p re di ct how much of the seleCted drug is

required or how long the course will last.

The

principle

applies to any state of fever bu t in

no

disease

perhaps

is this point

of

greater significance than

in

malaria,

for failure to appreciate it may mean the loss of a life.

THE SEVERE GROUP

Before deciding

on the

dosage

and

method of admini

stration of an antimalarial drug, one must assess the

clinical state of the patient. Signs of severity are indicated

by:

Restlessness.

2

H ig h fever f or 2

or

more days.

3 Vomiting repeated).

4. Severe and persistent headache.

5 Although a r ough guide , the more parasites r field as seen

microscopically

in

t he p er ip he ra l b lo od , t he mo re s eri ou sl y il l is

the patient.

These -features are more l ikely to be met in the non

immune subject exposed for the first time, although

this ru le is

not

absolute; in an immune subject a heavy

infection occasionally occurs and the pat ient may be

dangerously ill. Generally speaking, any of the following

may be regarded as belonging to the serious or poten

tially serious group:

I.

Acute fever in

an

infant

or

child.

2. A cu te fever asso ciated w it h dy sent er y or severe diarrhoea.

3. Acute fever with jaundice bilious remittent fever).

4. Signs of collapse with a weak pulse, a fever which is moderate

or only slight,

and

signs of renal impairment protein and casts

in t he u ri ne and a r aise d

blood

urea).

5. A cu te fever i n a pe rs on beyo nd mi ddl e age infected for t he

first time.

6

An

untreated case of acute fever of a few or several days

duration.

Forthe severe group quinine is the drug which should

be employed unless its use is contra-indicated; for it

has a rapid and specific a cti on w ith a marked effect

against asexual erythrocytic parasites.

When

a su bje ct

w ith m ala ria is acutely ill, qu in in e is given at first b y

intravenous injection but subsequent doses are admini

stered according

to

the condition of the patient. This

must depend en the practitioner s own judgment. If there

is much vomiting, signs of collapse, loss of fluid or

delirium, an intravenous drip infusion glucose-saline)

is set up at once and quinine dihydrocWoride gr.

1

for a n adult,

half

this

amount

for a child

and abou t

gr 4 for

an

infant) is injected into the rubber connection

o t i nto

the bottle), th e d ri p flowing in

at

a

rate

of

30 drops per minute. This method ensures a slow,

steady

and

safe administration of the drug. T he quin ine

is repeated in the same way every 6 hours until the

Documents

1.5 Topical Neomycin in Cervical and Viginal Infections With Special Reference to Bacillus Proteu