asthma it is unwise to attempt to control attacks by antibiotics, in fact the attacks may become pejorative. Again, administration of “shots” without effective physical examination “is not the way to practice medicine.” The free use of troches and lozenges containing antibiotics may result in a superinfection with thrush, or it may cause skin conditions. Mixtures of these agents have “little or no rationale.” It is better to choose one antibiotic on the basis of the infecting organism than to gunshoot in the hope of killing all organisms. Penicillin G (and its variations) remains the agent of choice in most instances. Germ resistance must not be allowed to supervene because of too much antibiotic medication. In the article, practically all the antibiotics now in use are Streptomycin and dihgdrostreptomycin mentioned. Only a few will be mentioned here. Chlortetramay be seriously toxic and may well be limited to treating tuberculosis. cycline (Aureomycin) and oxytetracycline (Terramycin) are useful but seem to tend to Chloramphenicol is cause toxicity and superinfections of the skin, mouth, vagina, etc. Carbomycin and erythromycin toxic and should be limited to treating typhoid fever. probably should be limited to treating streptococcal, staphylococcal, and pneumococcal infections. Their clinical action in toto has not been well verified as yet. Racitracin, when indicated, seems safe to use at this stage of our knowledge. Polympxin B may be Neomycin sulfate is helpful in used in infections caused by Pseudomonas neruginosa. preparing the colon for surgery. Mixtures of antibiotic-s nmy br administered in such conditions as acute bacterial endocarditis when the causative organism is an alpha or norihemolytic streptococcus. Such mixtures may be lifesaving. One must depend largel? upon conclusions drawn from experiments in vitro as to the efficacy of combinations of streptomycin, penicillin, bacitracin, and polymyxin R, but Long warns, “It does not seem to be wise to mix any of these antibiotics with aureomycin or terramycin.” Toxic reactions are an evil which it is difficult to overcome in the presence of a severely ill patient. ,4 history of previous reactions and of the amounts of antibiotics given on former occasions may enable one to estimate the possible calling forth of latent untoward responses. If an unpleasant experience has been noted after the administrat,ion of penicillin G, it is well to use penicillin 0 or some other antilliotic. Intolerance may be a definitely hidden factor. Chloramphenicol has been accused of causing certain tlyscrasias of the blood. However, out of 539 recorded cases of such dyscrasias, in onl- fifty-five could rhloramphenicol be suspected, since it was the sole drug used. It was notecl, though, that aplastic anemia? which has a uniformly bad prognosis, developed in forty-four (80 per cent) patients. The Food and Drug Administration has ruled that all preparations of chIoramphenico1 for oral use must bear special warnings as to its possible effects in producing hlood dyscrasias. T. J. C.
Clinical Significance of the Increasing Resistance of Organisms to the Antibiotics. 3’. L. 1953. Meleney, and B. A. Johnson. Surg., Gynec. & Obst. 97: 257 (September) Meleney and Johnson review the history of sulfonamide and penicillin usage in surgical infections and point out the various theories which attempt to explain the There is ample evidence that the more mechanism of bacterial resistance to antibiotics. often and the more indiscriminately any antibiotic is used, the more readily bacteria of all types develop resistance, and their progeny, propagating that resistance, fail to respond to treatment with the antibiotic. In extensive laboratory studies it has been found with almost every species of organism that those obtained from hospital inpatients were more resistant to antibiotics than those obtained from the outpatients. From year to year more and more patients are failing to respond to antibiotics indiscriminately selected and administered. This fact points to the necessity of determining as quickly as possible by means of laboratory tests the causative organisms and their sensitivity. These laboratory tests are not being employed as frequently as necessary in order for patients to receive the full benefit from present knowledge. T. J. C.