Medical Science Publication No. 4, Volume II
DISCUSSION
JOSEPH E. SMADEL,M. D.
The excellent presentation on leptospirosis by Colonel Yager purposelyomitted the subject of therapy which I will now take up quite briefly.Problems arising in the treatment of this disease were reviewed at lengthduring the Symposium on the Leptospiroses which was held at the Army MedicalService Graduate School during December 1952. I would call your attentionto the published report of this 3-day Symposium which appeared last year.The volume brings together current information on practically all aspectsof this important group of diseases.
The therapy of leptospirosis may be briefly summarized (1, 2)as follows: Evaluation of therapeutic measures in this group of infectionsis hampered by the variable severity of the disease. Thus, large groupsof carefully studied cases are necessary if valid conclusions are to bedrawn about the efficacy of any particular medicament. Over the years claimshave been made for the value in this group of diseases of a large numberof drugs and antibiotics. It would appear that none has any appreciabletherapeutic effectiveness once the disease is well
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established, which is the time when the physician usually sees the patientinitially. On the other hand, a number of the antibiotics are of valuein experimentally infected animals provided that treatment is given shortlyafter infection and before obvious or severe disease is well developed.There is some evidence that the similar early usage of those antibioticsin infected human beings may also abort or control the disease. Such findingsemphasize the need for further study of antibiotic therapy in explosiveoutbreaks of leptospirosis which occur when an appreciable number of personsare infected simultaneously or over a short period of time. In such outbreaksit should be possible to initiate treatment within a matter of hours afteronset of illness in those persons who sicken during the latter part ofthe epidemic, after the nature of the infection has been established byinvestigations on the first few cases appearing in the outbreak.
Preventive measures for the control of leptospirosis have been successfullyemployed under certain limited circumstances (3, 4). However, theprocedures have had little usefulness in the effective control of the diseasein military populations in tropical areas where leptospirosis is highlyendemic (5, 6).
References
1. Smadel, J. E.: Therapy of Leptospirosis. In Symposiumon the Leptospiroses, pp. 202-24, Medical Science Publication No. 1, U.S. Government Printing Office, Washington, 1953.
2. Gsell, O.: Discussion on the Therapy of Leptospirosis.Ibid., pp. 212-220.
3. Broom, J. C.: Prophylaxis and Control of Leptospirosis.Ibid., pp. 186-192.
4. Borg-Petersen, C.: Discussion of Prophylaxis and Controlof Leptospirosis. Ibid., pp. 193-201.
5. Broom, J. C.: Leptospirosis in Tropical Countries.A Review. Trans. Royal Soc. Trop. Med. Hyg. 47 : 273-286, 1953.
6. Hughes, W. D.: Discussion of Leptospirosis in TropicalCountries. Ibid., pp. 287-288.
