ANTIBIOTICS AS CHEMOTHERAPEUTIC AGENTS 279 



Other infections. It is suggested that an average of 750,000 units of 

 sodium penicillin be allowed for systemic treatment and 50,000 units 

 of the calcium salt for local treatment (275, 319). 



Penicillin is thus found to form a valuable addition to the growing 

 list of chemotherapeutic agents, to help man combat disease-producing 

 bacteria. It is commonly used not as a pure acid but as either a calcium 

 or a sodium salt, the former for local applications and the latter for 

 intramuscular or intravenous treatments (275, 494). Since penicillin 

 solutions are quite unstable, especially in the form of salts, the dry 

 preparations are stored and are dissolved either in water or in saline 

 just before required for use. Certain of the esters (e-butyl) of penicillin 

 which are inactive in vitro can, when given by the oral route, become 

 highly active against hemolytic streptococci (639, 640). 



In some cases, penicillin failures have been experienced 5 these may 

 be due to too brief treatment or too small doses, to need for surgical 

 drainage, or to other complications. Toxic effects may also be produced 

 due to the penicillin itself or to some of the accompanying impurities. 

 Sensitivity is often in the nature of allergy ( 159, 592). Further details 

 on the toxicity and in vivo activity of penicillin are reported by Herrell 

 (410). 



In place of penicillin preparations, crude culture filtrates are occa- 

 sionally used. Such crude preparations have been designated as vivi- 

 cillin, hypholin, etc. (500). 



This is not the place to discuss in detail the pharmacology and chemo- 

 therapy of penicillin. An extensive literature has already accumulated 

 on this subject. Reference is here made to the detailed summaries (274, 

 495) and books recently published, where indications for penicillin are 

 listed under infections due to staphylococci, Clostridia, hemolytic strep- 

 tococci, anaerobic streptococci, pneumococci, gonococci, anthrax, chronic 

 pulmonary suppuration, meningococci, bacterial endocarditis, murine 

 erysipelas, Vincent's syphilis, actinomycosis, diphtheria, and certain 

 others. It is not effective in mixed infections where a gram-negative 

 flora predominates, in urinary infections due to E. coli and other gram- 

 negative bacteria, in tuberculosis, in other diseases caused by gram- 

 negative bacteria, viruses, or pathogenic fungi, in malaria, or in a 

 variety of other diseases, such as cancer. The manner and extent of ad- 



