THE CAUSES OF SECONDARY FEVER IN SULFAPYRIDINE-TREATED PNEUMONIA

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Abstract
Among 339 cases of pneumococcus pneumonia treated with sulfapyridine there was a 2d rise in temp. in 32 cases, or 9.4%. In 7 of these patients the 2d fever was due to the drug (3 of these had a rash at the same time), in 15 it was due to relapse of the pneumonia, in 6 to recurrence of the pneumonia and in 4 patients to one of the complications typical of pneumonia. Drug fever began 2-5 days after the subsidence of the first fever and lasted 1-1/2-4 days. Among the 15 patients with relapse, 7 patients had been adequately treated (as demonstrated by high free blood sulfapyridine levels) ; 8 had been inadequately treated or the adequacy of treatment was doubtful. In this latter group, no patients died, whereas 4 patients died among the 7 patients who had a recurrence of the pneumonia in spite of adequate treatment. 6 patients recovered entirely from the first attack of pneumonia and suffered a recurrence with disappearance of the original type of pneumococcus from the sputum and the appearance of a new type. One patient had bacteremia during each attack of pneumonia, each time caused by a different type of pneumococcus. All patients recovered from the 2d attack of pneumonia. The incidence of recurrence of pneumonia following sulfapyridine administration seems greater than in patients treated symptomatically or with specific serum.