Waksman — 186 — Actinomycetes 



three, penicillin and sulfadiazine were required; and six cases were cured 

 by sulfonamide drugs. In two cases in which sulfonamide medication 

 was given, the disease ended fatally. The conclusion was reached that 

 both penicillin and sulfonamides are highly effective drugs in the treat- 

 ment of the anaerobic forms of actinomycosis. A detailed study of the 

 effectiveness of penicillin on various actinomycetes, including the repre- 

 sentatives of the different genera, has recently been made by Drake 

 (95). 



Patients suffering from infections due to the aerobic N. asteroides 

 have benefited from treatment with the sulfonamide compounds and 

 penicillin; this benefit was similar to the effect upon patients infected 

 with the anaerobic A. hovis. Surgical drainage, iodides, and roentgen 

 ray therapy are recommended as the indications arise (92). Two cases 

 of pulmonary and chest wall infections with acid-fast Nocardta gave 

 good response to rest treatment, surgery, vitamins, sulfonamides and 

 iodides (30). 



Numerous contributions have recently been made concerning the 

 treatment of actinomycosis with penicillin, alone (248) or in combina- 

 tion with sulfadiazine (93, 119, 209, 345). However, in a case of 

 nocardiosis which resembled pulmonary tuberculosis, only intensive 

 therapy with sulfadiazine was recommended; penicillin and strepto- 

 mycin failed (139). 



Actinomycosis of the central nervous system responded clinically to 

 treatment with sulfadiazine, penicillin and streptomycin (183). Holm 

 (177) surveyed the penicillin-sensitivity of anareobic actinomycetes. 

 Their sensitivity was found to be similar to that of staphylococci. If 

 whole colonies were used, however, in making the tests, some were 

 found to be more resistant. The resistance of the typical "sulfur gran- 

 ules" in the pus to penicillin may be due to this phenomenon. The 

 dosage and mode of administration of penicillin should therefore be 

 controlled by the presence of such granules. 



Various strains of A. hovis, including both human and bovine iso- 

 lates, were found to be highly sensitive to penicillin, all being inhibited 

 by a concentration of 0.5 unit per milliliter. They developed only 

 slight resistance to penicillin upon continuous transfer in media con- 

 taining this antibiotic. The strains were inhibited by 30 units per 

 milhliter of streptomycin. All strains rapidly developed a high degree 

 of resistance upon consecutive transfer in media containing strepto- 

 mycin. Both resistance and reversion to original sensitivity occurred in 

 a step-wise manner suggesting the possibility of genetic changes in the 

 organism (39a). 



