The Current Status of Parenteral Carbenicillin

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Abstract
Based on in-vitro susceptibility, carbenicillin is the least toxic drug with significant activity against Pseudomonas aeruginosa and indole-positive Proteus; it is frequently active against Enterobacter, Serratia, and other gram-negative bacilli important in nosocomial infections. It is highly effective in controlling bacteriuria due to these organisms and in the treatment of bacteremia in patients with underlying immunologic impairment. In sepsis resulting from burns and in patients with impaired host defenses carbenicillin is clearly useful, possibly uniquely so. Additional studies are required to relate its role to that of the aminoglycosides. Resistant mutants exist with regularity in large bacterial populations, and episomal, transferable resistance has also been observed. Both types of resistant bacteria may emerge during or after treatment of patients. Superinfection, especially with Klebsiella, is an important problem in the type of patients who require carbenicillin. The side effects are those characteristic of all the penicillins and, in addition, those related to the large amount of sodium administered with the high dosage of carbenicillin necessary for treatment of sepsis. The efficacy and relative lack of toxicity of this antibiotic for serious gram-negative bacillary infections should be considered in the light of the likelihood of emergence of resistance in the very bacteria for which it is most useful. The early recommendation for restriction of its use to patients with serious infections still remains valid.

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