184 An Introduction to Medical Mycology 



(g) Prognosis.— When localized, the disease usually responds well to 

 treatment. In the systemic varieties, the issue is doubtful but not hopeless 

 unless the brain and the spinal cord become affected. The period of involve- 

 ment is important; infections of long duration are of graver portent than 

 those of recent origin. The prognosis also depends on the nature of the 

 treatment and on the efficiency with which it is carried out. The virulence 

 of the infection may vary, and the natural immunity of the host also seems 

 to be of importance in many cases. 



(h) Treatment.— This should be undertaken as soon as the ray fungus 

 has been demonstrated in pus. Even when the outlook is favorable, prog- 

 ress is slow and several months are required for cure. The following meas- 

 ures are usually employed. 



(1) Preferred.— Combined therapy using penicillin, sulfadiazine and 

 roentgen irradiation is advocated by Lamb and others and appears at 

 this time to be superior to other schemes. It is recommended in all forms 

 of the disease. 



A. Penicillin. This drug should be given intramuscularly, 40,000 units 

 every three hours to a total dose of at least 6,000,000 units. 



r. Sulfadiazine. In 1938, Walker reported favorable results from the ad- 

 ministration of sulfanilamide. There has since been ample evidence that the 

 sulfonamides are useful agents. We prefer sulfadiazine because of its low 

 toxicity. The dose at first should be from 4 to 6 Gm. daily, reduced to 2 Gm. 

 daily after clinical improvement. Sodium bicarbonate should be prescribed 

 to be taken coincidentally. It may be necessary to continue sulfonamide 

 therapy for two to three months. The urine and blood should be examined 

 regularly. 



c. Roentgen rays. This is usually administered to accessible lesions in 

 semi-intensive dosage with some filtration. The treatment should be re- 

 peated at intervals of three or four weeks. In cases of systemic infection, 

 high voltage therapy usually results in symptomatic relief. 



(2) Other measures. 



a. Iodides. It is customary to use a saturated solution of potassium iodide, 

 first giving 10 drops three times daily before meals in a glass of water. 

 The dose may be increased 5 drops each day until symptoms of intolerance 

 develop. Patients with actinomycosis appear to have more 1 than average 

 tolerance for iodides, and large doses (up to 200 to 300 drops or more per 

 day) are frequently well tolerated. Tincture of iodine may be given instead 

 of potassium iodide, and other forms of iodide medication may be substi- 

 tuted to provide a change for the patient during the long course of treat- 

 ment. It is usually necessary to continue the administration of the iodides 

 for several months. 



