454 ANNUAL REPORT SMITHSONIAN INSTITUTION, 19 45 



PENICILLIN THERAPY 



To return to the subject of penicillin, a pertinent fact concerning 

 its action is that, just as certain sulfonamide-fast bacteria are sensitive 

 to penicillin, so there has been reported evidence of organisms which 

 are persistently resistant to penicillin. The cause may be natural, 

 acquired by prolonged contact, or due to small colony variants. So 

 far as is known, no cases have been reported yet where sulfonamide- 

 fast organisms have proved resistant to penicillin, and vice versa, 

 which is gratifying. 



Any list of pathologic conditions and states in which penicillin was 

 known or believed to be effective must of necessity be considered incom- 

 plete. Certainly present research programs and the results which 

 will be gained from usage of the drug will undoubtedly broaden its 

 field of indications. It is already evidenced that where it is equally 

 as efficacious as other measures, including sulfonamides, economic 

 factors and mode of administration govern usage. 



A concise and helpful report on indications for penicillin was pre- 

 pared in 1944 by Dr. Chester Keefer, chairman of the committee on 

 chemotherapy of the National Research Council, and consultant to 

 the Office of Scientific Research and Development, for the War Pro- 

 duction Board's Office of Civilian Penicillin Distribution. Based on 

 accumulated experience, it was found that penicillin was the best 

 therapeutic agent available for the treatment of certain conditions, 

 as follows : 



All staphylococcus infections with and without bacteremia : Acute and chronic 

 osteomyelitis, carbuncles — soft tissue abscesses, meningitis, cavernous or lateral 

 sinus thrombosis, pneumonia — empyema, carbuncle of kidney, wound infections — 

 burns, and endocarditis. 



All cases of Clostridia infections: Gas gangrene, malignant edema. 



All hemolytic streptococcic infections with bacteremia and all serious local 

 infections: Cellulitis, mastoiditis with intracranial complications, i. e., men- 

 ingitis, sinus thrombosis, etc., pneumonia and empyema, puerperal sepsis, peri- 

 tonitis and endocarditis. 



All anaerobic streptococcic infections : Puerperal sepsis. 



All pneumococcic infections of meninges, pleura, endocardium. All cases of 

 sulfonamide-resistant pneumococcic pneumonia. 



All gonococcic infections, especially those complicated by arthritis, ophthalmia, 

 endocarditis, peritonitis, epididymitis. All cases of anthrax ; chronic pulmonary 

 suppuration in which surgical treatment is contemplated. All meningococcic 

 infections failing to respond to sulfonamides. All cases of bacterial endocarditis 

 due to susceptible organisms. 



Originally listed in a second group, where penicillin has also been 

 found effective, but its position not definitely defined, were syphilis, 

 bacterial endocarditis, and actinomycosis. It is now generally recog- 

 nized that syphilis and bacterial endocarditis are proper indications 



