412 ANNUAL REPORT SMITHSONIAN INSTITUTION, 1952 



ancy. Under experimental conditions, increasing the dose from 10 

 to 100 units per kg. results in a slightly decreased renal clearance. 

 This agrees with the observation that after relatively large doses in 

 animals, damage to the tubules of the kidneys occurs rapidly and this 

 damage is reflected in the later excretion rate. 



AUREOMYCIN 



In aureomycin we have a chemotherapeutic agent that can be used 

 without fear of serious toxic effects. Untoward side effects consist of 

 anorexia, nausea, vomiting, epigastric distress, heartburn, and diar- 

 rhea, which occur more often in females than in males. The diarrhea 

 often persists for several weeks but may be helped by the administra- 

 tion of kaolin, pectin, or bismuth. Sometimes patients complain of 

 a bizarre desire for certain types of food, and occasionally there is a 

 compelling and voracious appetite for any kind of food. Other side 

 effects that have been reported following aureomycin are stomatitis, 

 cheilosis, skin and mucous membrane eruptions, and vaginitis. In ad- 

 dition, a Herxheimer type of reaction has been observed in cases of 

 brucellosis treated with aureomycin. These conditions usually do not 

 interfere with treatment. Early commercial lots of aureomycin caused 

 more nausea, vomiting, and diarrhea than those now available. It is 

 certain that, although the drug itself may cause these symptoms in 

 patients, a relatively large number of the early reports of toxic mani- 

 festations were due to the presence of impurities. Present-day aureo- 

 mycin is recrystallized three times and, as a result, a product of ex- 

 tremely high purity is available for clinical use. 



The diarrhea observed in patients treated with aureomycin for a 

 period of three or more days may not be a toxic manifestation of the 

 drug, but rather an expression of the profound effect this drug has 

 on the intestinal flora. In this respect it is similar to terramycin or, 

 for that matter, any combination of chemotherapeutic agents that are 

 markedly active against both gram-positive and gram-negative aerobic 

 and anaerobic bacteria of which the intestinal flora are comprised. 

 Oftentimes, patients treated with these broad-spectrum antibiotics for 

 a period of 3 days or more show nothing but pure cultures of yeast in 

 their stools. Not infrequently the stools become loose, lose their nor- 

 mal odor, and the patient complains of pruritus ani. The latter is 

 probably due to the abnormal shift of the bacterial flora to the acid- 

 producing yeasts. 



There is a relatively low incidence of vomiting in patients treated 

 with aureomycin and this may be controlled quite readily with alkalies 

 and, in some instances, milk. The use of aluminum hydroxide is not 

 recommended since it interferes with proper absorption. 



