Penicillin's Progress

The new wonder drug penicillin (TIME, Feb. 8) is doing even better than expected. In the Lancet, Britain's H. W. Florey, who first sponsored the drug, recently described the largest series to date of penicillin-treated (and usually cured) cases. The patients had osteomyelitis, septicemia, eye infections, meningitis, chronic infected wounds. Findings:

>Unlike sulfa drugs, penicillin has not yet shown any harmful effects. A patient's appetite often increases; his anemia may improve.

> Best way to give penicillin is by injections into muscle or (in localized wounds and infections) by salve, powder or solution. Results of dosage by mouth are fair at best.

> Penicillin is quickly eliminated in the urine. A physician must continually check its concentration in a wound or in the blood stream to make sure enough is present to prevent bacteria from multiplying (penicillin does not kill bacteria; the coup de grace is delivered by the white blood cells).

> In heavy bloodstream infections, dosages should be large from the start (about 15,000 units every three hours). With too-small doses, bacteria sometimes develop penicillin resistance.

> Sulfa drugs characteristically produce sudden drops in body temperature, but less spectacular penicillin, which may take weeks to save a life, usually reduces temperature by easy stages.

> Dr. Florey believes some surgical operations might be revised to take advantage of penicillin, tried it in 22 cases of mastoid. Immediately after operation, the incision was stitched up with a small rubber tube running to the bottom of the wound and closed by a spigot. Every six hours the tube was drained and filled with a penicillin solution. After a week the tube was removed. Nineteen of the cases were healed and only three needed any further treatment.

> Dr. Florey reported the treatment of old wounds with draining sinuses. They were filled with penicillin solution and stoppered with a rubber bung. The solution was changed twice a day. Of eleven wounds which had persisted for three months to twelve years, seven healed in four weeks.

Dr. Florey ended on the discouraging, realistic note that "penicillin is as yet available in only the smallest quantities." The A.M.A. gave a similar warning last week to U.S. doctors: though Merck & Co., E. R. Squibb & Sons, Charles Pfizer & Co and the Lederle Laboratories are all making penicillin, "in no instance has production advanced beyond the pilot-plant stage," and supplies for civilian use will be "exceedingly limited." The Army recently tried penicillin on a few veterans from the Pacific suffering from compound fractures, osteomyelitis and wound infections. First results were so good that the Medical Corps will soon extend trials to 16 hospitals, has ordered 100 times as much penicillin as can be made in a year at present rates.

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