The effect of chloramphenicol in Salmonella enteritis of infancy.

During the year 1951, in the Royal Children's Hospital, Melbourne, chloramphenicol was used for the treatment of numerous children with infective diarrhoea, and an impression was gained that it was relatively ineffective in the treatment of Salmonella enteritis, despite the high sensitivity of the group to chloramphenicol in vitro. Experimental work on mice by Seligmann and Wassermann (1949) indicated that chloramphenicol was bacteriostatic rather than bacteriocidal to Salmonella. The clinical results of Ross, Burke, Rice, Washington and Stevens (1950), Weiner and Liebler (1951) and Kunstadter, Milzer and Kagan (1951) on small series of patients supported this finding, but the variable clinical course of Salmonella enteritis, even when untreated, made assessment th -efficacy-ofanrtibioi difficult. In some cases the organism temporarily disappeared from stools during treatment, but reappeared soon after cessation of therapy. Fison and Singer (1950), in treating an outbreak of infantile diarrhoea due to Salmonella, formed the opinion that chloramphenicol was responsible for decreasing morbidity and mortality, and other reports of single cases or small series supported this view. At the Royal Children's Hospital, Melbourne, from November, 1951, to March, 1953, a controlled clinical therapeutic trial to determine the efficacy of chloramphenicol on infants suffering from Salmonella enteritis was carried out. During this period, 390 infants less than 2 years of age were admitted to hospital with the diagnosis of infective diarrhoea. Salmonella were grown from the stools of 98 of these infants, 51 of whom were studied in the controlled trial.