THE AGGRAVATING EFFECT OF SOME ANTIBIOTICS ON THE NEUROMUSCULAR BLOCKADE IN MYASTHENIA GRAVIS

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Abstract
According to the literature, the following compounds have effects which tend to reduce neuromuscular transmission: Sulfonamides, streptomycin, dihydrostreptomycin, neomycin, viomycin, kanamycin, colimycin, polymyxin A and B and paromomycin, and also possibly tetracyclin and oxytetracyclin. These effects do not in general cause marked clinical disturbances in normal adults, but may lead to a condition of severe weakness when occurring together with other compounds having similar effects, such as ether and some muscle relaxants. A similar harmful influence may also appear in the illness where the neuromuscular transmission is already disturbed, as in Myasthenia Gravis. Six myasthenic patients are described. Streptomycin and dihydrostreptomycin caused a clear increase of clinical muscular weakness in them all, the extent of which was proportional to the severity of the patient''s illness. Neostigmine and edrophonium did antagonize this effect, although incompletely in some cases. Only in one patient did kanamycin lead to a gentle weakening of muscular strength. Penicillin had no harmful influence upon any of the patients tested, and in one of them the tetracyclin used was harmless. On the basis of these observations the right choice of antibiotics is emphasized especially for those patients whose illness can be brought into a state of equilibrium only with difficulty.