Sulfacetamide, methenamine, and mandelic acid were studied in an effort to determine which drug or combination of drugs is the most useful in the treatment of urinary tract disease. Utilizing a described method of analysis, results are reported of attempts made to produce resistant strains of organisms to the three drugs and four combinations of them. Finding the combination of all three drugs to be most useful, an excretion study was made using human subjects. UE TO THE development of bacterial fastness t o many of the newer antibacterial drugs, methenamine and mandelic acid have taken a more prominent position in modern concepts of therapy in urinary tract disease. Duca and Scudi (1) and Scudi and Duca (2)have reported that methenamine mandelate possesses antibacterial activity comparable t o sulfonamides in urinary tract disease, but with t h e added advantage that the causative organisms have difficulty in becoming fast to these drugs. Duca and Scudi have demonstrated t h a t organisms made resistant t o sulfathiazole remained susceptible t o methenamine mandelate. Sulfacetamide has been reported t o be among the least toxic but one of t h e most effective of the sulfonamides against urinary tract pathogens ). Several investigators have reported a simultaneous increase of resistance b y t h e organisms t o the sulfonamides after exposure t o only one of these drugs (3, 8, 9). Similar reports have been made regarding t h e antibiotics by Fusillo and Romansky (10) and Herrell, et al. (11). However in 1947, Welebir and Barnes (6) reported that certain sulfanilamide-resistant, mandelate-resistant, and sulfathiazole-resistant organisms remained susceptible to sulfacetamide.
This paper reports results of attempts made to produce strains of organisms resistant t o sulfacetamide, methenamine, mandelic acid, and various combinations of these drugs, in an effort to determine which of t h e drugs or combinations possess t h e widest antibacterial spectrum and the lowest resistance liability.