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Free Content The early bactericidal activity of streptomycin

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Abstract:

SETTING: Patients with sputum smear-positive, newly diagnosed pulmonary tuberculosis studied at Tygerburg Hospital, Cape Town, for their early response to streptomycin (SM).

OBJECTIVE: To determine the standard early bactericidal activity (EBA), namely the fall in viable counts of tubercle bacilli in 16-hour sputum collections during the first 2 days of treatment with SM.

DESIGN: Patients were randomised to logarithmically spaced daily doses of 7.5, 15 or 30 mg/kg SM. A comparison by standard biological assay methods was then made with previous estimations of the EBA of paromomycin in doses of 7.5 and 15 mg/kg.

RESULTS: An EBA of 0.133 obtained with 30 mg/kg SM differed significantly from zero (P = 0.0009), while the EBAs of 0.043 with 15 mg/kg and -0.025 with 7.5 mg/kg did not so differ. A linear regression equation of EBA = -0.2587 + 0.2627 log10 dose was obtained with significant slope (P = 0.007). Paromomycin was estimated to be 1.745 more potent than SM with wide 95% confidence limits (0.6–28.6), indicating that it cannot be considered more potent than SM.

CONCLUSIONS: The low EBAs show that SM has low, dose-related, bactericidal activity in cavities, consistent with results from clinical trials. If streptomycin-resistant bacilli are present, paromomycin is probably the aminoglycoside of choice.

Keywords: EBA; early bactericidal activity; paromomycin; pulmonary tuberculosis; streptomycin

Document Type: Regular Paper

Affiliations: 1: Department of Paediatrics, University of Stellenbosch, Cape Town, South Africa 2: Tuberculosis Research Lead Programme, Medical Research Council, Tygerberg, South Africa 3: Department of Pharmacology, University of Stellenbosch, Cape Town, South Africa 4: Department of Internal Medicine, University of Stellenbosch, Cape Town, South Africa 5: Medical Research Council Clinical Trials Unit, London, UK 6: Department of Medical Microbiology, St GeorgeÕs Hospital Medical School, London, UK

Publication date: August 1, 2002

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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