The Clinical Application of Antibiotics—chloramphenicol and the Tetracyclines

IT is just twenty-nine years since the discovery of penicillin and sixteen years since it w,as first used as a therapeutic substance. Penicillin, the first antibiotic, was the forerunner of some thousands of antibiotic substances, only a small fraction of which have provred to be of therapeutic value. One of the main reasons for this was the toxicity of many of the substances and their tendency to produce serious, side-effects when administered in therapeutically effective doses. Experience has shown that most of the antibiotics, currently in use and invaluable in treatment, are also associated with undesirable side-effects, and Dr. Schindel's book presents a review of the literature dealing wvith the side-effects of thirteeni antibiotics wvidely used in U.S.A. Only two of these, fumagillin and cycloserine, are not as yet in general use in this country. A chapter is devoted to each of the antibiotics, except the tetracyclines which are grouped together in one chapter. The side-effects of each antibiotic are discussed under the headings of (1) allergic and hypersensitivity reactions, including changes in skin and mucous membranes, urticaria, contact dermatitis and local irritation at site of injection; (2) systemic reactions, such as anaphylactic shock, serum sickness-like reactions; (3) specific organ reactions, including blood changes, dlamage to liver, kidney, bowel, and nervous system, and (4) sequelx such as acute enteritis, fuingus infections, especially with C. albicans, and associated deficiencies of vitamin K and the vitamin B complex. The author has described with bibliographical references every known side-effect associated with the administration of antibiotics. As he points out, the litcrature about antibiotics issued by commercial firms usually contains the sentence: "This product is practically free from undesirable side-effects." This book, therefore, serves a useful purpose in collating evidence to counter this over-optimistic view, and should be of value to clinicians by making it clear that none of the antibiotics is blameless from the point of view of causing side-effects, varying from local irritation at the) site of injection to severe or fatal gastro-enteritis, aplastic anxmia, or moniliasis. It is a pity there are so many errors in spelling, e.g., "bacterix," "penicillase," "urobilinurea," "htmophilus influenza" (not italicized). The construction of some of the sentences would suggest a literal translation from German and in a few places the meaning is unintelligible. Despite these defects which should be corrected in a future edition, this small volume should be read by those who wish to recognize at the earliest stage of treatment the undesirable reactions associated with the use of the common antibiotic. v. D. A.