The Local Use of the Sulfonamide Drugs

Abstract

Since the introduction of sulfanilamide and its derivatives, the reliance upon chemotherapy for the control of acute surgical infections has temporarily overshadowed the importance of sound surgical principles and often has resulted in the administration of inefficient or inadequate treatment. Too often, the physician fails to recognize the limitations of chemotherapy and vainly attempts to control the infection well beyond the optimum time for surgical intervention.

Chemotherapy is very effective in controlling infections from hemolytic streptococcus; is moderately effective in controlling staphylococcic infections; but is of slight value when administered systemically in patients infected with the nonhemolytic streptococcus or colon bacillus. However, even in infections caused by the hemolytic streptococcus or the staphylococcus, sulfanilamide and sulfathiazole cannot replace surgery after suppuration has taken place and mechanical drainage of an abscess is required. It is in the treatment of lymphangitis and cellulitis, not in the treatment of abscesses, that chemotherapy has been of the greatest value.

The work of Lockwood¹ and others has indicated that the products of proteolysis in vitro interfere with the bacteriostatic and bacteriocidal powers of sulfanilamide. The presence of similar substances in undrained abscess cavities probably interferes with the destruction of the organisms by chemotherapy. Accordingly, the sulfonamide drugs should supplement rather than replace early and adequate surgical drainage, especially in the presence of suppuration.

The local application of the sulfonamide drugs is based upon the principle that the local concentration of the drug in the tissues is ten to twenty times as high as that which. . .