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In this series a very large therapeutic dose of corticosteroid was administered by retention enemata. For the first week the author gave the equivalent of between 300 and 750 mg. of cortisone daily and for the next three weeks 150 to 375 mg. daily. The results were excellent but systemic effects were noted in all who received more than the smallest dose used.
The efficacy of betamethasone 17-valerate (5 mg) and prednisolone 21-phosphate (20 mg) retention enemata in the outpatient treatment of distal proctocolitis was compared in a formal clinical trial. The two treatments were equally effective in inducing remissions of the disease, but the betamethasone valerate enema produced less adrenal suppression.
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These observations show that thiomersal, used as a bacteriostatic agent for retention enema solutions, irritates the colon. Investigations leading to the choice of a non-irritant bacteriostatic agent are described. The presence or concentration of sodium chloride in the solution does not seem to be important.
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