THE DISTURBANCE OF THE NORMAL BACTERIAL ECOLOGY BY THE ADMINISTRATION OF ANTIBIOTICS WITH THE DEVELOPMENT OF NEW CLINICAL SYNDROMES

Abstract

Prolonged therapy with penicillin suppresses or eliminates Gram-positive bacteria and stimulates directly or indirectly the multiplication of Gram-negative bacilli. Prolonged therapy with relatively large doses of streptomycin may suppress the Gram-negative bacilli and stimulate the growth of Gram-positive cocci. This effect is not so constant as that induced by penicillin therapy. The prolonged admn. of both penicillin and streptomycin simultaneously, or of aureomycin, chloramphenicol or terramycin may suppress both Gram-positive cocci and Gram-negative bacilli to such a degree that the fungi of the yeast and mold types from the normal ecologic flora multiply and produce disease in the mouth, vagina, bronchi, lungs and intestinal tract. Vit. deficiencies of the B complex type, including the syndrome of pellagra, may follow the prolonged admn. of the newer broad coverage antibiotics. Antibiotics should not be used in mild and ill-defined infections because a drug sensitivity may develop which will prevent the subsequent use of the antibiotic in a major illness. The dangers of inducing sensitivity are greatest when the antibiotic is applied locally. The newer antibiotics, with broad coverage spectrums, should not be admd. for more than 1 wk. at a time unless the etiologic agent causing the infection has been identified and the indications for prolonged therapy are obvious. A complete vit. supplement, with special emphasis on the B complex group, should tie given to all patients receiving prolonged therapy with the newer antibiotics.