Side-effects of penicillin treatment.

In comparison with the many millions of injections of penicillin given annually all over the world, the incidence of reported reactions to the drug is small. Untoward effects vary from simple discomfort at the site of injection to sudden death (Kern and Wimberley, 1953; Welch, Lewis, Kerlan, and Putnam, 1953). The amount and duration of pain at the injection site may vary with the technical skill of the operator, or with the type of penicillin used, or both. Reports of sudden death suggest that these are anaphylactoid in nature (Siegal, Steinhardt, and Gerber, 1953; Pick and Patterson, 1953). The "terror" reactions described by Batchelor, Horne, and Rogerson (1951) and further similar cases reported by Mayer, Mosko, Schutz, Osterman, Steen, and Baker (1953) and Berger and Eisen (1955) also appear to be anaphylactoid. In addition, delayed reactions, intermediate in severity between the two extremes described, may occur. These delayed reactions are serum sickness-like, with erythema, urticaria, pruritus, joint swellings, and orbital oedema in varying degrees (Winton and Nora, 1955). Exfoliative dermatitis may also occur (Langdon, 1950). Manufacturers warn us that nurses may show skin sensitivity from handling penicillin. Mention has been made of the possibility of precipitating manifestations of lupus erythematosus by penicillin (Gold, 1951). Erythemovesicular or "ide-like" reactions probably indicate previous sensitivity by dermatomycosis. Serum sickness-like and anaphylactoid reactions are those which have caused the most trouble. As regards the mechanisms underlying these sideeffects, many believe that the penicillin moiety, itself, is the cause. Winton and Nora (1955) have suggested that the penicillin links up with serum albumin (sic) to cause the serum sickness type of reactions. The procaine element in the procaine penicillin preparations has been mentioned as a possible cause of anaphylactoid reactions, but this idea does not seem to have received general support (Thomson, 1952). In Thomson's case he believed