Antibiotics and terramycin (1952)

is a world in conflict but in this world of apos [ __ ] there is order Nature has its own balance to each action there is reaction out of violence tranquility but even in the peaceful scene the conflict of energy and mass continues this opposing force extends into the biological world antagonisms in the animal kingdom though not as dramatic conflict in the plant world goes on unrelentingly parasites fungi which feed upon the life of other lands of microorganisms in the soil though he did not know why primitive man searched for certain molds to treat some of his ills in his crude medical practices he had begun to employ biologically antagonistic forces he was using a phenomenon which even today is understood in completely from a beginning such as this comes the story of modern antibiotic therapy over the years Tyndale pastor and later fleming witnessed a new phenomenon some stray impurity found its way into Fleming's laboratory and onto nutrient medium he observed the phenomenon of anti bios's a biological antagonism one microorganism inhibiting another this anti microbial action is a complex one which even today is not fully understood slowly the men of science began to study the phenomenon and the possibilities down through the history of man infection the growth of pathogens within the body has taken its impressive toll within man there was a counter active force against disease the thin line of body resistance which allowed man to survive in the world surrounded by pathogens body resistance wasn't completely effective however diseases welled up again and again against this protective barrier a few anti-infective drugs were developed antisera vaccines and heavy-metal antibiotic drugs each helped to reinforce the protective barrier but only against the one disease sulfonamides opened the era of comprehensive chemotherapy for the first time medicine had an agent which could act upon a group of organisms though the spectrum was relatively narrow but it was penicillin which revolutionized the therapy of diseases of infection it was the first biological antagonist of disease the first true antibiotic bacitracin more recently developed is effective within the penicillin range of activity streptomycin was second true antibiotic to be developed its spectrum complements and somewhat overlaps that of penicillin when used in combination the two drugs serve as a relatively broad spectrum antibiotic used alone each is effective against its own group of diseases polymyxin another of the antibiotics developed earlier is available for systemic use its spectrum is somewhat similar to streptomycin although it is not effective against the tubercle bacillus and then from the molds came antibiotics of even broader usefulness forums finical oreo myosin terramycin these broad-spectrum antibiotics are revolutionary but although they have similar spectra there are significant differences among them while each of these antibiotics has its value it is only fair to point out the limitations which distort the otherwise perfect therapeutic picture every drug has toxicity and side reactions such as occasional nausea or diarrhea an infrequently Eastover growth occurs the practitioner recognizes them and learns to exercise judgment in each case another limitation is the development of resistant strains of bacteria the pattern varies with each drug for example strain resistance to streptomycin develops rapidly the broad-spectrum antibiotics on the other hand follow the penicillin pattern of slow resistance development in any case the benefits far outweigh these disadvantages the earlier drugs continue to be useful just as today's drugs will be useful when even newer ones are developed despite their value it must be kept in mind that the antibiotics are only a supplement to body resistance this symbolic line of resistance consists of a complex of elements antitoxins license agglutinins phagocytes endocrine responses and other undetermined factories for a moment we'll take a portion of this line to symbolize arbitrarily all of body resistance when the body defense mechanisms are strong and efficient antibiotics of course are not necessary in general they are indicated in for situations where resistance cannot handle the infection if an infection is caused by exceptionally virulent organisms resistance is overwhelmed antibiotic administration enables resistance to resume its effectiveness when there are too many bacteria body resistance is unable to cope with a number again the antibiotic may enable resistance to resume its effectiveness when resistance is low the clinician must rely primarily on the antibiotic to handle the infection and used prophylactically the drug suppresses the growth of bacteria to be acceptable as a therapeutic agent an antibiotic should possess certain desirable characteristics it should be easy to administer it should have a wide margin of safety between the therapeutic dose and the toxic dose it should be readily absorbed into the body its antimicrobial action should not be inhibited by the body fluids allowing the drug to act in any location it must be effective against invading organisms in vivo and throughout the range of the body temperatures it should not interfere with phagocytic activity it should not antagonize the effects of other agents and finally microbial mutation causing bacterial resistance should not develop readily terramycin the newest of the three broad-spectrum antibiotics was discovered in the soil it was developed from an action of my seat Streptomyces Ramos's it was originally extracted and concentrated as the crystalline form and has always been available in this pure form as a result toxicity and side reactions have been minimal terramycin is amphoteric it forms alkaline and acid salts both terramycin and it's salts are therapeutically active the structure of terramycin is unique in nature the molecule contains no chemical groups known to be harmful the carboxyl group is similar to those which link amino acids in proteins the dimethyl amine group explains the solubility of terramycin in acid while the oxygen in these systems accounts for its solubility in alkaline solution terramycin maintains its potency for years at room temperatures among the physical properties the solubility should be mentioned the salts are soluble in acid in alkaline water and in the common organic solvents forming relatively stable solutions these useful properties complement the high antimicrobial potency of terramycin which can be observed readily in nutrient media in vitro studies foreshadow the therapeutic applications and the clinical effectiveness of the drug any broad-spectrum antibiotic is effective against an impressive list of microorganisms however as strains developed which are not affected by the antibiotic such a list is only a guide to therapy in general the gram-positive bacteria which are sensitive to terramycin are these the sensitive gram-negative bacteria are these also sensitive or spirochetes Rickettsia protozoa and even some of the larger viruses these are the terramycin sensitive microorganisms for the various types of infections which occur in the body there are several dosage forms of the drug the intravenous preparation may be used in those severe cases where high and immediate concentrations are desirable oral suspension may be employed concentrated drops may be used orally in infants instilled beyond the region of the taste buds or dosage may be in the form of capsules or tablets the orally effective antibiotic must not lose potency in the acid gastric juice or in the alkaline fluids the elementary tract it must be absorbed into the bloodstream to give rapid therapeutic concentrations which lasts for several hours periodic administration of terramycin approximately every 6 hours maintains these concentrations however the concentrations are assured only if nothing interferes with the absorption Co incidentally administered alumina gels physically absorbed the drug which decreases absorption on the other hand milk which helps to eliminate gastric distress does not interfere with absorption this broad-spectrum antibiotic alters the flora of the bowel which incidentally is a valuable adjunct for intestinal surgery there are numerous clinical conditions in which an antibiotic is indicated because it is carried in the blood to all parts of the body it is effective both in the body tissues and in the bloodstream bacteremia is a serious complication even in this day of antibiotics terramycin is affecting this disease is positive and rapid as it comes in direct contact with the bacteria in the bloodstream high blood levels give high tissue and body fluid levels which lead to high tissue concentrations of antibiotic infections in tissues therefore also respond where the blood supply is poor however infection cannot be handled readily as an example abscesses are diminished only by natural healing which may be assisted by the antibiotic effect in all such cases proper surgical management should be exercised urine is another body fluid in which terramycin is effective since the drug is concentrated and stable in urine it is useful in non-obstructive infections of the tract and associated structures here the infection is controlled both through the urine and through the blood nonspecific as well as venereal infections normally respond and when the causative organism is sensitive diseases of the genital tract may be treated successfully these infections are vaginitis cervicitis endometritis and sal tingle or ofer itis infections occurring during pregnancy such as payal itis can be controlled with proper handling at the same time the antibiotic traverses the placental barrier into the fetal circulation however there are no adverse effects post-partum infections are also successfully controlled by the drug as antibiotics are carried in the bloodstream they are effective not only in these deep infections but in superficial disorders as well in addition infections of the skin and of the eye may be treated by topical therapy severe infections such as meningitis may require very intensive antibiotic therapy even when the organism is sensitive terramycin is absorbed by brain tissue penetrating the blood-brain barrier quite well during infection although ineffective against the common cold antibiotics are useful in prevention and treatment of its complications sinusitis otitis tonsillitis and descending infections laryngitis tracheitis bronchitis bronchopneumonia and the other pneumonias mixed bacterial and pneumococcal pneumonia of the classical type can be treated effectively during all stages morbidity and mortality have been significantly decreased in addition terramycin is employed in viral and rickettsial types of atypical pneumonia these diseases are reported to respond only to the broad-spectrum antibiotics while x-ray findings may take time to regress symptomatic improvement occurs soon after administration here too morbidity has been greatly reduced the list of diseases affected by terramycin is long but necessarily broad-spectrum activity will not cure all infections as a guide to therapy it is good clinical practice to isolate the organism identify it and test it for sensitivity by exposing it to graduated delusions of the antibiotic this is advisable as it may be a naturally resistant organism such as Proteus or the frequently resistant Pseudomonas aeruginosa even some of the more common bacterias such as Staphylococcus I possess resistant strains antibiotic therapy can be started immediately after the culture is taken and sent to the laboratory in this way immediate broad-spectrum activity is assured in most cases it can be continued until the infection is controlled no drug is perfect but here at the bedside perfection can be approached therapeutically ultimately then the responsibility comes back to the physician the man who applies the skills and drugs of modern medicine the tools of our culture are as effective as the men who wield them