THE MICROBIOTICS — McDONNELL 455 



for penicillin therapy. Recently added was diphtheria, especially in 

 horse-serum-sensitive patients. 



Keefer listed in a third group certain conditions of questionable 

 value, in mixed infections of the peritoneum and liver in which the 

 predominating organism is of the gram-negative flora, such as rup- 

 tured appendix, liver abscesses, urinary-tract infections and in rat-bite 

 fever due to streptobacillus moniliformis. 



Penicillin was contraindicated (meaning that the drug was of no 

 value and where administration might cover up symptoms or forestall 

 other proper therapeutic measures, not that any danger was present 

 from toxicity) in the following cases because it is ineffective : 



All gram-negative bacillary infections : Typhoid — paratyphoid, dysentery, E 

 coli, H. influenza, B. proteus, B. pyocyaneus, Br. mclitensis (undulant fever) 

 P. tularense (tularemia), B. friedlander. 



Tuberculosis, toxoplasmosis, histoplasmosis, acute rheumatic fever, lupus 

 erythematosis diffuse, infectious mononucleosis pemphigus, Hodgkins' disease, 

 acute and chronic leukemia, ulcerative colitis, coccidiomycosis, malaria, polio, 

 myelitis, blastomycosis, nonspecific iritis and uveitis, moniliasis virus infections, 

 cancer. 



ADMINISTRATION 



Penicillin must be administered in rather large doses at first to create 

 a satisfactory blood level, and for parenteral administration repeated 

 administration is required thereafter at 4-hour intervals or continu- 

 ously because it is readily excreted and only sparingly absorbed. The 

 drug is inactivated to some extent when administered orally. How- 

 ever, it has been reported that if large enough quantities are given 

 orally, adequate blood levels may be attained. Various methods of 

 protecting orally administered penicillin have been successfully dem- 

 onstrated and products such as tablets and lozenges are available. 



Penicillin is supplied in ampuls and vials of 100,000 or 200,000 

 Oxford units each, and when kept at refrigeration temperature will 

 retain its potency for over 2 years. Inasmuch as penicillin is soluble, 

 it may be dissolved in small amounts of sterile, distilled, pyrogen- 

 free water, or in sterile, normal saline solution. When large-unit sizes 

 are being used in hospitals, the contents of the vial should be dissolved 

 so that the final concentration is 5,000 units per cc. This solution 

 should be stored under aseptic conditions in the ice box. Kirby and 

 others have reported that solutions will retain their potency for several 

 weeks and even when kept at room temperature it was found that 

 potency remained for more than a week. 



For intravenous use the dry powder is dissolved in sterile physio- 

 logical salt solution in concentrations of 1,000 to 5,000 units per cc. 

 or higher, for direct syringe injection. It may be dissolved in sterile 

 saline or 5 percent glucose at 25 to 50 units per cc. for constant intra- 



