FURTHER OBSERVATIONS ON THE TREATMENT OF TYPHUS FEVER WITH PARA-AMINOBENZOIC ACID

Abstract

From 1943 to 1945, large amts. of p-aminobenzoic acid (PABA) were adm. to 95 typhus patients of various nationalities. Statistically significant differences are noted between the PABA-treated and the untreated groups as regards duration of fever, incidence of complications, and mortality. Treatment begun early in the 1st wk. of illness was more effective than treatment begun later. The form, route of adm., periodicity of dosage, and duration of treatment are discussed. Emphasis is placed on the importance of attaining promptly and maintaining throughout the course of therapy a cone. of the drug in the blood; > 10 mg. % for Rickettsia prowazeki and 35 mg. % for R. orientalis. The urine must be kept neutral or alkaline in reaction during treatment. The transient lowering of the white blood cell count observed in some patients was the only definite evidence of toxic reaction to PABA. The initiation or continuance of PABA therapy is contraindi-cated under the following circumstances: (a) if crystals appear in the urine; (b) if the white blood cell count falls below 3,000/cu. mm.; (c) if the polymorphonuclear leukocytes are reduced to < 25% of the total count. Secondary bacterial infections do not preclude the use of PABA for rickettsial diseases. Penicillin is advocated to supplement PABA in the treatment of secondary infections.