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were treated again and in one the Providence was eliminated and the urine remained
sterile for
2\
years, in the other patient the Providence infection recurred three times
after penicillin treatment. Although further experiences at Stoke Mandeville have shown
that Providence strains as any other strains may become resistant against any antibiotic
including Penicillin G, these studies on the beneficial effect of Penicillin G in the treat
ment of certain acute and subacute urinary infections are worthwhile remembering.
Colley & Frankel also refer to one patient who had been unsuccessfully treated with
Furadantin, tetracycline and streptomycin for a chronic Providence infection and who
was cured of this infection while having treatment with Penicillin for a superficial boil.
His urine remained sterile for three years. It may also be mentioned that Penicillin was
also successfully used in the treatment of Proteus septicaemia (Hutchinson & Randall,
1947; Holloway & Scott, 1956). Bors & Comarr (1971) in assessing the frequency of
micro-organisms encountered in 489 urine cultures on 33 spinal cord injury patients,
found the following to be the most frequent: Proteus mirabilis (21-8 per cent), Proteus
Rettgeri 17-2 per cent Pseudomonas 14-7 per cent, Aerobacter aerogenes 13-2 per cent
and Escherichia coli n-8 per cent and Paracolon-Providence 6-5 per cent. This would
correspond more or less—allowing variations in frequency within these groups—to the
experience of most workers in this field.
The many brands of new antibiotics developed in the last 10-15 years have given the
clinicians a great choice in the treatment of urinary infection, although none has proved
a universal remedy for the various groups of Gram-negative organisms. One of the most
popular antibiotic used is still the tetracycline group (Terramycine) which, however,
as any other antibiotic, should not be used routinely but should be reserved for active
bladder infection as evidenced by a bacterial count of more than 100,000 ml and increased
number of white or red cells, and especially in pyelitic attacks. There is no doubt that
pyuria is clinically more significant and therefore more indicative for immediate action
than bacteriuria.
When streptomycin became available, we carried out systematic studies on the effect
of this antibiotic on mono- and pluribacterial urinary infections in paraplegics with
various types of bladder paralysis (Guttmann, 1953). I*1 accordance with previous
investigators (Petroff & Fricas, 1946; Pulaski, 1946) we found streptomycin effective,
especially in those cases who were catheter-free or did not require regular catheterization.
Administrations of streptomycin in pyelitic attacks, both in catheter-free patients and
those still under suprapubic or urethral drainage, resulted in dramatic clinical improve
ment, with prompt disappearance of septic effects, decrease of leucocytosis and improve
ment of renal function. The antibacterial effect of streptomycin was also seen in cases
with very long standing urinary infection, as found in the few survivors (mainly incom
plete lesions) from the 1914-18 World War.
The routine course of streptomycin treatment, as used at Stoke Mandeville in an
acute infection of pyelo-nephritic type, was as follows: Intramuscular injections were at
first given at three-hourly intervals, the first three doses being 0-8 g each, followed by
three doses of 0-5 and this was followed by doses of 0-2 g, to a total amount of 8 g, in
special cases up to 10 g. No adverse toxic effects of any significance were observed in the
great majority of patients during and after the treatment described. Some patients would
