ANTIBIOTIC SUBSTANCES 23 5 



ides in the treatment of S. aureus infections with and without bacteri- 

 emia, including acute and chronic osteomyelitis, cellulitis, carbuncles of 

 the lip and face, pneumonia and empyema, infected wounds and burns. 



A study of 500 cases of infections treated with penicillin led to the 

 following conclusions (479, 549) : Penicillin can be administered intra- 

 venously, intramuscularly, or topically, but is ineffective when given by 

 mouth. As it is excreted rapidly in the urine, it must be injected continu- 

 ously or at intervals of 3 to 4 hours. Penicillin was found to be particu- 

 larly effective in the treatment of staphylococcic, gonococcic, pneumo- 

 coccic, and hemolytic streptococcus infections, especially sulfonamide- 

 resistant gonococcic infections, but not bacterial endocarditis. The usual 

 patient requires a total of 500,000 to i, 000,000 Oxford units, the best 

 results being obtained when treatment is continued for 10 to 14 days, 

 10,000 units to be given every 2 to 3 hours at the beginning of treat- 

 ment, either by continuous intravenous injection or by interrupted in- 

 travenous or intramuscular injections. Good results were obtained by 

 injections of 100,000 to 160,000 units over a period of 2 to 3 days. In 

 the treatment of empyema or meningitis it was found advisable to use 

 penicillin topically by injecting it directly into the pleural cavity or the 

 subarachnoid space. Toxic effects were extremely rare. Occasional chills 

 with fever or headache and flushing of the face were noted. 



A summary of the response of different bacteria in septic gunshot 

 fractures is given in Table 43. Staphylococci and streptococci are rapidly 

 responsive to penicillin therapy. Anaerobic cellulitis due to the proteo- 

 lytic bacteria of putrid wound infection responds to penicillin, but the 

 bacteria may persist in the presence of devitalized tissue or wound 

 exudates. Pyocyaneus is not susceptible to penicillin and is considered to 

 be relatively unimportant as a single pathogen in the surgical manage- 

 ment of the wound (272, 548). 



In view of the inefficacy of the sulfa drugs for the treatment of 

 burns, a detailed study has been made (133) of the utilization of peni- 

 cillin applied to the wound in the form of a cream. In 54 wounds thus 

 treated, penicillin had a lOO per cent effect upon the hemolytic strepto- 

 coccal flora, in 7 cases the strains being insensitive to sulfonamide. 

 The staphylococci also disappeared, although somewhat more slowly. 

 Healing was usually rapid and no toxic effects were observed. Gram- 



