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Treatment of Pneumococcic Meningitis:  Results When Penicillin Was Used Alone Compared With Those When Penicillin and Streptomycin Were Used Together, With and Without Hydrocortisone: Alternate Patient Studies

MARK H. LEPPER, M.D.; HAROLD W. SPIES, M.D.
AMA Arch Intern Med. 1959;104(2):253-259. doi:10.1001/archinte.1959.00270080079010.
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The results of treatment of patients with pneumococcic meningitis have varied widely.1-21 While some of the variations may be attributed to the choice of treatment, particularly with antibacterial agents, the magnitude of differences has been as great between different clinics using the same regimen as between different regimens in the same clinic. Several factors, such as the quality of supportive treatment and availability of nursing services, may influence results, but the nature of the patient being treated appears to be of primary importance. This is emphasized by analysis of the difference in results in various age groups and of the complicating diseases and the acuity of the illness among those patients who die as compared with those who recover.

The effect of factors of selection of patients entering a hospital on prognosis made the study of this disease by alternate case method seem necessary. Because of the fact that

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