1960年 · 第11卷第03期

It is known that furacilin (nitrofurazone) is a powerful bactericidal and bacteristatic agent for both gram-negative and gram-positive organisms. However, its use is mainly limited to external application. From May to December 1959, a joint study was carried out in Shanghai to investigate systematically its effect on bacillary dysentery. The study consisted of clinical evaluation and experiments on drug sensitivity and stability of resistance.

236 children with bacillary dysentery were treated with furacilin. The dosage was 10-20mg per kg per day (with an average of 15 mg per kg per day) , divided into four doses, for a course of 7-10 days. Among these 236 patients, complete cure was observed in 196 (83.3%) , improvement in 24 (10%) and failure in 16 (6.7%) . Within three days after the initiation of therapy, the temperature returned to normal in 66.7% of the cases; the frequency of stools was reduced to below three a day in 58%, and reversal of positive stool cultures to negative was noted in 47.5%. At the end of the treatment course the latter figure increased to 83%. Toxic effects were observed in 13 cases, 8 manifesting skin eruptions, 3 developing peripheral neuritis and one each had vomiting and drowsiness.

The drug sensitivity test and test for stability of resistance of Shigella dysenteriae were carried out in vitro. The method was employed to determine the drug sensitivity of 13 local strains of various serotypes of Sh. dysenteriae and two standard stock strains (flexneri types 3 and 6) . It was found that growth in concentrations up to 1.6-3.1 r per ml of furacilin could be considered as very susceptible; 6.3-12.5 r per ml, moderately susceptible and higher than 25 r per ml as resistant. According to this preliminaryestimation most of the strains tested were very susceptible to furacilin on initial contact. Gradual increase of the concentration of furacilin during subsequent cultivations showed that the speed of emerging resistance was quite variable among different strains of Sh. dysenteriae. Shigella flexneri types X and Y developed resistance to the highest level of concentration (50 r per ml) used after the second generation, and Shigella sonnei, after the third generation, while Sh. flexneri types 3 and 6 of the standard stock strain did not develop resistance until the ninth or tenth generation. Of two strains of Sh. flexneri type 4a, one developed resistance to furacilin at a concentration of 50 r per ml after the second generation and the second after the fifth or sixth generation. The results of experiments on drug established, resistance lasted over 30 generations in drug-free cultivations. This was in marked contrast to the response of Sh. dysenteriae against other antibiotics such as chloramphenicol.

In brief, furacilin is a cheap and useful chemotherapeutic agent against bacillary dysentery, but indiscriminated use should be avoided because once resistance is induced by the drug it becomes very stable.

This paper reports on the clinical use of Pteris ensiformis Burm鳳尾草in bacillary dysentery. The plant is known as pai chiao chi and is found in South China, especially in Wenchou, Chekiang province.

The active principles are obtained from the herb leaves and the medicine is taken usually in the form of 50% solution.

From March to August 1959, 85 cases of various types of bacillary dysentery were studied in Kwang Ts'e Hospital, Shanghai Second Medical College. Most of the cases were either nontoxic, chronic or drug resistant. All of them were treated with Pteris ensiformis alone.

52% of the cases were between 1 and 3 years old. The average dosage used was 30-45 gm regardless of age and body weight. The minimum daily dosage was 15 gm and the maximum was 60 gm. The larger daily dose taken all at once gave better clinical results.

8 cases were treated in addition with retention enemas consisting of the same solution and dosage as used in oral therapy. No additional benefit from such treatment was obtained.

The course of treatment was between six and ten days. About 57% of the cases were curea completely.

The organism in 30 cases out of 39 in which sensitivity tests were done proved to be resistant to chloramphenicol and syntomycin. These cases responded to Pteris ensiformis treatment with 46.6% cured.

Sensitivity tests with Pteris ensiformia were studied in 30 cases, but no correlation with clinical observations was found.

The following results were observed: Pus and blood in stool disappeared after 6.2 days, temperature returned to normal after an average of 4.7 days, abdominal pain subsided after 3.7days, and negative stool culture was obtained after 5.5 days.

The side actions of the drug were few; only 32% of the cases presented some distress in the digestive tract, i.e., vomiting, anorexia and abdominal discomfort. However, when the treatment was discontinued, symptoms subsided spontaneously. No serious toxic reaction was noted. pteris ensiformis is an effective drug with minimal toxicity and is valuable for the treatment of bacillary dysentery.