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War Surgery and Medicine

Recommendations on Treatment by Consultant Physician 2 NZEF, July 1943 — Meningitis

Recommendations on Treatment by Consultant Physician 2 NZEF, July 1943

Cerebro-spinal (Meningococcal)

M & B 693 (Sulphapyridine)

For the first 3 days a total of 8–10 gms. daily.

For the next 6 days a total of 3 gms. daily.

Thus—1st day: 1st and 2nd doses 4 tabs each then 2 tabs every 4 hours.

2nd and 3rd day: 6 doses of 3 tabs every 4 hours.

4th to 9th day: 6 doses of 1 tab each every 4 hours.

In fulminating cases or with vomiting, use Sulphapyridine soluble—

First dose: 1 gm. in saline intravenously.

and the same dose intramuscularly.

Second dose: 1 gm. intramuscularly 4 hours later.

After six days' treatment, a daily leucocyte count to forestall agranulocytosis.

During treatment: 4 to 6 pints of fluid daily, and some alkali, e.g. sod-bicarb. No purges; enemas or liquid paraffin, if required. Symptomatic treatment as required.

Pneumococcal and Pyogenic

Sulphadiazine—10 c.c. of a 30 per cent sol. (3 gms.) in P. aeq. normal saline intravenously

2 injections daily for 4 days.

1 injection daily 5th and 6th days.

The drug is obtainable in 10 c.c. ampoules. Instructions given by ME say the drug requires no further dilution. This, in our experience, obliterates the veins by thrombosis, and soon no suitable vein can be found. Fluids, etc., as in the meningococcal variety.

We have reason to believe that while Sulphadiazine may clear pneumococci out of the CNS [central nervous system], the blood may still act as a reservoir—e.g., a case, apparently cured of pneumococcal meningitis, and after ten days of apparent normal convalescence, suddenly developed rigors and died of acute pneumococcal endocarditis. We have since used in addition to Sulphadiazine from the 4th day onwards, M & B 693 in the same way as in pneumonia.