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链霉素诞生于五十年前。

[Streptomycin was born fifty years ago].

作者信息

Gonzales J

机构信息

Biologie de la reproduction. Hôpital Pitié-Salpêtrière, Paris.

出版信息

Hist Sci Med. 1994;28(3):239-48.

Abstract

The discovery of streptomycin by Waksman in 1943 marked the beginning of true chemotherapy in all forms of tuberculosis. The possibility to reverse the lethal course of tuberculous meningitis in children constituted a hope verged on enthusiasm. But after encouraged results, skepticism arose: cases of resistance of BK to streptomycin were reported and other observations noted severe sequelae when administration had begun too late. Successes due to drug were often weakened by side effects like cochlear and vestibular deficiencies. All those reservations came in addition to the great price of streptomycin, difficulties of its supply and doubts upon long term prognosis for cared patients. Finally streptomycin won. In the following years, new drugs more and more efficient against tuberculosis were used, instead of streptomycin which some enthusiastic people had nevertheless thought only able to eradicate the "white plague". Today, morbidity and mortality from tuberculosis remain dramatic, partly accelerated by the AIDS epidemic and increased by high frequency of cases with BK resistance to all drugs ... except streptomycin. What a long story, full of hopes, for this antibiotic which, during the first clinical trials, saved from certain death ... a child became the author of the present paper!

摘要

1943年瓦克斯曼发现链霉素标志着各种形式结核病真正化疗的开端。逆转儿童结核性脑膜炎致命病程的可能性带来了近乎狂热的希望。但在取得令人鼓舞的结果之后,怀疑论出现了:有报告称结核杆菌对链霉素产生耐药性的病例,而且其他观察发现,用药过晚时会出现严重的后遗症。药物带来的成功常常因诸如耳蜗和前庭功能缺陷等副作用而大打折扣。除了链霉素价格高昂、供应困难以及对接受治疗患者的长期预后存在疑虑之外,还有所有这些保留意见。最终链霉素胜出。在接下来的几年里,使用了越来越多对结核病更有效的新药,取代了链霉素,尽管一些热心人士曾认为链霉素只能根除“白色瘟疫”。如今,结核病的发病率和死亡率仍然很高,部分原因是艾滋病流行加速了这一情况,而且对所有药物(除链霉素外)耐药的结核杆菌病例频繁增加……对于这种在首次临床试验中曾将一名儿童从必死无疑的境地中拯救出来的抗生素而言,这是一个充满希望的漫长故事!而这名儿童如今成了本文的作者!

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