PHARMACOLOGY OF ANTIBIOTICS — WELCH 403 



system can be diminished directly in proportion to the destruction of 

 the antibacterial properties of the drug. 



Toxic reactions to oral therapy with penicillin have been reported 

 on numerous occasions. Black tongue or glossitis may occur in 

 patients treated with troches or with troches and sprays. Stomatitis 

 following the use of penicillin as troches or by inhalation has been 

 reported. There are other side effects resulting from penicillin 

 therapy which may be classified as rather indefinite reactions. These 

 include gastrointestinal disturbances, muscle cramp, flushing of the 

 skin, and headache. These reactions are observed not infrequently 

 and some have been described as being allergic in nature. The symp- 

 toms are difficult to explain but rarely, if ever, are they sufficiently 

 severe to necessitate withdrawal of the drug. One of the serious re- 

 actions to penicillin in man is the Herxheimer reaction in syphilis. 

 This "therapeutic shock" presumably represents a reactivation of the 

 syphilitic process which sometimes follows the use of any potent anti- 

 syphilitic drug. The Herxheimer reaction has followed the use of 

 penicillin in both early and late syphilis and alarming manifesta- 

 tions may occur in cases of cardiovascular and neurosyphilis. Deaths 

 have occurred presumably following Herxheimer reactions during the 

 use of penicillin therapy in syphilis. Fortunately, this type occurs 

 infrequently. 



Of more importance because of their possible universal occurrence 

 are the allergic manifestations which may be observed following use 

 of penicillin. The early belief that allergic reactions were connected 

 exclusively with the impurities in penicillin has been thoroughly dis- 

 credited by the mass of data to the contrary. Undoubtedly the im- 

 purities in amorphous penicillin increased the possibility of 

 sensitization, but the pure crystalline drug itself is quite capable of 

 causing an allergic reaction in man. Sensitization with crystalline 

 penicillin approximating the theoretical potency of 1,667 units per 

 mg. may occur in individuals who have never had previous contact 

 with the drug. About 5 percent of individuals exhibit a positive reac- 

 tion of the tuberculin type to penicillin, despite the fact that they have 

 not had previous contact with the drug. In addition to those indi- 

 viduals who are sensitive on primary contact with penicillin, there is 

 a group of probably 10 percent of the population that may become 

 sensitive following brief or prolonged treatment. Certain individuals 

 become sensitive following a few injections and others require many. 



Probably the most common reaction to penicillin is urticaria. This 

 may vary from a single or few transient erythematous wheals to the 

 diffuse massive plaques of angioneurotic edema which may be local- 

 ized on the hands, lips, eyelids, vulva, or larynx. Epidermal hyper- 

 sensitivity to penicillin is more likely to occur following topical 



