Landmark article June 14, 1941: Sulfadiazine. Therapeutic evaluation and toxic effects on four hundred and forty-six patients. By Maxwell Finland, Elias Strauss, and Osler L. Peterson.

sulfadiazine appeared to be as effective as sulfapyridine or sulfathiazole in every condition in which it was used. Toxic effects from sulfadiazine were relatively mild and infrequent. Nausea and vomiting occurred in 9.

Serotypes of Streptococcus pneumoniae isolated from blood cultures at Boston City Hospital between 1979 and 1982.

Serotypes of pneumococci causing bacteremia were examined from January 1979 through December 1982. Of the 271 isolates recorded, 52% were from adults and 48% were from children. The rate of pneumococcal bacteremia for adults was 2.

Empiric therapy for bacterial infections: the historical perspective.

The term empiric is defined, and its implications in the treatment of infectious diseases and the selection of beta-lactam antibiotics are discussed. Some changes in the choice of empiric therapy during the last half-century are brought out by a discussion of therapy for selected infections. For some infections the changes (if any) have been only minor; for others, however, the changes have resulted in a progressive decline in mortality, a shortening of the course of the disease, and the reduction or elimination of complications.

Pneumococcal pericarditis: a persisting problem in contemporary diagnosis.

We reviewed the clinical and laboratory features of six patients with pericarditis caused by Streptococcus pneumoniae who were admitted to Boston City Hospital. The diagnosis of pneumococcal pericarditis was delayed or missed entirely during life in all patients. The frequent absence of pericardial friction rubs and cardimegaly on chest roentgenograms contributed to the difficulty in recognizing this illness.

Pneumonia and pneumococcal infections, with special reference to pneumococcal pneumonia. The 1979 J. Burns Amberson lecture.

An etiologic classification of acute pneumonia was presented and the relative importance of some of the causative agents was briefly reviewed. The early developments of the therapy of pneumococcal pneumonia with type-specific antisera, sulfonamide drugs, and antimicrobial drugs were reviewed, mostly from the experiences of the author at Boston City Hospital. Changes in the occurrence and relative importance of the pneumococcus as a cause of infections associated with bacteremia, empyema, and meningitis were demonstrated, based on cases observed at Boston City Hospital during 12 selected years between 1935 and 1972.

Emergence of antibiotic resistance in hospitals, 1935-1975.

A limited review of the changes in susceptibility of common bacterial pathogens to available antibacterial agents is presented. Significant developments in recent years include the following: (1) the emergence of Streptococcus pneumoniae with decreased resistance to penicillin and of some strains resistant to several antibiotics; (2) a decline in prevalence of multi-drug-resistant Staphylococcus aureus after 1960 following their increasing prevalence in the preceding years (these changes were methicillin-resistant (and multi-drug-resistant) S. aureus and the marked differences in their prevalence in different areas (these changes also were related to appearance of new phages in those organisms); (4) an increasing resistance to multiple drugs among enterococci but not among viridans streptococci or among nonenterococcal group D streptococci; (5) the emergence of beta-lactamase-producing Neisseria gonorrhoeae; (6) the emergence and spread of sulfonamide-resistant Neisseria meningitidis; (7) the occurrence of beta-lactamase-producing strains of Haemophilus influenzae and occasional strains resistant to chloramphenicol; (8) the focal occurrence of chloramphenicol-resistant Salmonella typhi in Vietnam and in epidemic form in Mexico; (9) the demonstration of marked differences in prevalence of resistance to multiple drugs in common pathogens to the most widely used antibiotics in different geographic areas.

Bacteremic superinfections of patients with bacteremia: occurrence, bacteriology, mortality, and duration of hospitalization at Boston City Hospital during 12 selected years between 1935 and 1972.

During the course of hospitalization of 6,414 patients with bacteremic infections identified at Boston City Hospital (Boston, Massachusetts) during 12 selected years between 1935 and 1972, 6.0% developed verified bacteremic superinfections with organisms not isolated or identified in the primary bacteremic infection. Analysis of these cases reemphasizes the increasing occurrence of serious hospital-acquired infections despite the successive introduction and intensive use of a large number of effective antibacterial agents.

Duration of hospitalization for bacteremic infections at Boston City Hospital during 12 selected years between 1935 and 1972.

In survivors of both community-acquired (CA) and hospital-acquired (HA) bacteremic infections at Boston City Hospital during 12 selected years between 1935 and 1972, the mean hospital stay fluctuated widely from one selected year to the next, but it was generally shorter and early discharges were more frequent in the years when effective antibacterial agents were used. The greatest reduction in hospital stay occurred by 1941. The size of the fluctuations and reductions also varied with the causative organism.

New developments in antibiotics. Future clinical studies for the National Institute of Allergy and Infectious Diseases.

The classes of anti-infective agents and the numbers in each class that are currently available and in use in the United States are listed, and current activity with respect to discovery and development of new drugs in the most widely used categories is briefly reviewed. Fifteen major areas for future research in the therapy and control of infectious diseases are recommended, and the relative roles for industry, academic and clinical investigators, and government (National Institute of Allergy and Infectious Diseases) in these areas are discussed. There are many problems requiring extensive research and financial support.

Duration of hospitalization for acute bacterial empyema at Boston City Hospital during 12 selected years from 1935 to 1972.

The duration of hospitalization for acute bacterial empyema of the pleura was determined for all cases at Boston City Hospital during 12 selected years between 1935 and 1972. Patients whose infection was acquired after admission stayed in the hospital longer than those in whom the empyema, or the infection of which the empyema was a complication, was present at the time of admission. The differences were mostly related to serious underlying disease in the hospital-acquired cases.

Changing ecology of acute bacterial empyema: occurrence and mortality at Boston City Hospital during 12 selected years from 1935 to 1972.

The occurrence, etiology, and demography of acute bacterial empyema are presented to reflect the widespread use of sulfonamides, penicillin, and other active antibiotics. In community-acquired (C-A) cases Streptococcus pneumoniae, hemolytic streptococci, and Staphylococcus aureus were the most frequent single organisms identified in initial positive cultures of pleural fluid during 1935. S.

Quantitative inhibition of Haemophilus influenzae by trimethoprim/sulfamethoxazole.

We evaluated the inhibitory effect of trimethoprim (TMP) and sulfamethoxazole (SMZ), alone and in combination, against 34 strains of Haemophilus influenzae. Growth inhibition was determined after incubation for 18 h by comparing viable counts of cultures in drug-containing medium with corresponding counts of control cultures in drug-free medium. In a modified, thymidine-deficient Levinthal broth, the numbers of colony-forming units of all the isolates tested were reduced 100-fold or more by TMP/SMZ (1.

Acute bacterial meningitis at Boston City Hospital during 12 selected years, 1935-1972.

Data are presented on the occurrence of and mortality rate from acute bacterial meningitis at Boston City Hospital during 12 years between 1935 and 1972 selected in relation to the introduction of potent antibacterial agents. The most frequent causative organisms were Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae, but large proportions were caused by other gram-positive cocci and gram-negative bacilli. The greatest reduction in mortality rate after antibiotics became widely used was in patients with meningococcal and influenzal meningitis who were less than or equal to 19 years old.

Duration of hospitalization for acute bacterial meningitis at Boston City Hospital during 12 selected years, 1935-1972.

An analysis is presented of the duration of hospitalization of the patients with acute bacterial (purulent) meningitis which occurred at Boston City Hospital during 12 selected years between 1935 and 1972. Considerable differences in the length of stay in the hospital were noted depending on the bacterial etiology, whether the infection was present on admission or acquired within the hospital, and, of course, whether the patient survived or died. Most of the deaths occurred within the first few days after admission or after the diagnosis was first established, but even among fatal cases, the survival time differed depending on the etiology and site of acquisition of the infection.

In vitro activity of p-hydroxybenzyl penicillin (penicillin X) and five other penicillins against Neisseria gonorrhoeae: comparisons of strains from patients with uncomplicated infections and from women with pelvic inflammatory disease.

Minimum inhibitory concentrations (MICs) of six penicillins against 95 strains of Neisseria gonorrhoeae from patients with uncomplicated anogenital infections and 22 strains from women with pelvic inflammatory disease were determined by an agar plate dilution method, using an inocula replicator. Against all 117 strains, the order of activity observed was: BL-P1654 > penicillin X > penicillin G > ampicillin > amoxicillin = carbenicillin. MICs against strains isolated from women with gonococcal pelvic inflammatory disease were significantly higher than those against isolates from uncomplicated infections: BL-P1654, P < 0.