Abstract
Sulfanilamide, which is successfully used in the treatment of patients suffering from purulent meningitis due to beta-hemolytic streptococcus and meningococcus, is readily absorbed after oral administration and is found in the blood and spinal fluid; usually, the concentration in the spinal fluid is somewhat lower than in the blood (Marshall, Emerson, and Cutting 1 2 ). Some authors, including Schwentker, Gelman and Long 3 as well as Crawford and Fleming 4 recommend that sulfanilamide may be given in certain cases by intrathecal injection. This form of administration is indicated particularly when treatment by other routes is not successful. It seemed desirable to determine what concentrations of sulfanilamide are reached and maintained in spinal fluid and in blood following intrathecal injection of the drug. In the following note, observations are reported dealing with this problem.
The studies were carried out in the following manner: Patients on whom a lumbar puncture was indicated for diagnostic reasons and whose spinal fluid was found to be normal, were given intrathecally 10 cc of an 0.8% solution of sulfanilamide (Prontylin, re-purified for injection, Winthrop) in physiological saline solution. Four and 18 hours following this injection, lumbar punctures again were performed, and at the same time blood specimens were taken. The concentration of sulfanilamide in both spinal fluid and blood, was determined according to the method described by Marshall, Emerson and Cutting 1 ; 2 standard solutions, containing 10 mg % and 1 mg % of sulfanilamide respectively were used.
The results obtained in 5 patients were essentially the same. Table I presents the findings of 2 of the cases. It may be seen from this table that 4 hours after the intrathecal injection of 80 mg of sulfanilamide a relatively high concentration (10–16 mg %) of the drug is present in the spinal fluid, but that the concentration in the blood at this time is much lower; in our series, the concentration of sulfanilamide in the blood amounted to 1 mg % or less.
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