RESPONSE OF PULMONARY NOCARDIOSIS TO TREATMENT WITH MASSIVE DOSES OF PENICILLIN INTRAVENOUSLY - REPORT OF A SUCCESSFULLY TREATED CASE WITH 4-YEAR FOLLOW-UP OBSERVATION, TOGETHER WITH REVIEW OF LITERATURE

Abstract

A case of cervical and pulmonary nocardiosis with chest wall involvement and osteomyelitis of the ribs is presented. Nocardia asteroides was isolated from sputum, lymph nodes, and chest drainage, and was tested in vitro against a large series of antimicrobial agents. The patient failed to respond to the following drugs in various combinations: sulfaethyl-thiadiazole, sulfadiazine, isoniazid, sulfoxone sodium, amphotericin B, and broad- spectrum antimicrobials (including chloramphenicol and tetracycline). There was dramatic response to a regimen consisting of massive doses of penicillin together with probenecid and sulfadiazine which was unexpected in view of the known penicillin resistance of most strains of Nocardia. Enhancement of action of sulfadiazine against Nocardia by large doses of penicillin warrants further study.