Ampicillin given parenterally may be preferred because of its low toxicity although this hazard is very rare with chloramphenicol given for 4 to 5 days only. In cases of haemophilus meningitis that do not respond quickly to chemotherapy with a single drug, streptomycin or sulphadiazine (or sulphadimidine) may be additionally prescribed. The chemotherapy of chronic bronchitis is concerned with:-
(a) Control of the chronic infection.
(b) Treatment of acute exacerbations.
For the former, only cases with purulent sputum will respond and for them, ampicillin or trimethoprim— sulphamethoxazole (cotrimoxazole) may be preferred to tetracycline because of their two-step bactericidal activity. Opinions differ as to whether one of these drugs should be given continuously through the winter months or intermittently, as indicated by sputum purulence or clinical relapse.
There is evidence of an increasing incidence of tetracycline-resistant pneumococci from cases of acute and chronic respiratory infections.For the acute exacerbation, in which haemophili or pneumococci, or both, may be implicated, treatment is urgent and parenteral injections of combined penicillin and streptomycin or of ampicillin for 5 to 7 days are indicated.
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