PENICILLIN IN THE TREATMENT OF ESTABLISHED SURGICAL INFECTIONS

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Abstract
A systematic study was made of published reports on the effects of penicillin in the treatment of established surgical infections in 744 cases, including 82 septicemias. In about 15% of the cases the response to penicillin therapy was excellent, in 50% good, in 18% questionable, and in 18% poor. An analysis of the cases that respond to the antibiotic reveals that the best scores were obtained in cases of cellulitis, mastoiditis, carbuncles, etc., which responded in >75% of the cases. Among the intermediate group were deep abscesses, thrombophlebitis, sinusitis, infected wounds, etc. The poorest results were obtained in empyema, burns, gas gangrene, actinomycosis, postoperative pneumonia, peritoneal abscess and diffuse peritonitis. The most significant feature of the study was the bacteriological analysis of the flora of the exudates produced in the surgical infections. One species of organism was usually found in the acute infections while a mixture of organisms was frequently obtained in the chronic type. The importance of classifying the organisms responsible for the infections is stressed. The most favorable response to penicillin treatment occurred in pure staphylococcal infections. Very little, if any, effect was obtained in conditions caused by Gram-negative bacilli. Cases in which no appreciable effect was obtained revealed organisms capable of producing penicillinase. Penicillin may be considered a valuable adjunct to surgery in the treatment of surgical infections.

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