Medicine: Drugs Are Dangerous Too

Doctors have found that antibiotics are great germ killers. Why different antibiotics kill different groups of germs they do not know. But, just as a hopeful pool player with no clear shot will try a combination, so will they. If penicillin alone will not work in a particular case, they may try penicillin and aureomycin together. But haphazard combinations of antibiotics may delay, instead of hasten, the patient’s cure.

Researchers at the University of California have found that there are about as many cases of antagonism between the drugs as there are of cooperation. By & large, they report, any two of four antibiotics in Group I—penicillin, streptomycin, bacitracin and neomycin—work well together. Except in rare cases, however, none of these four should be used with an antibiotic from Group II: aureomycin, Chloromycetin, terramycin. And while no great harm may come of combining two antibiotics within Group II, no real advantage can be expected either; the combination simply works like a bigger dose of either drug alone.

What complicates the job for doctors and laboratory workers is that a particular combination of drugs may work well against one kind of disease-causing microbe and be useless against another closely related microbe. Fortunately, the exceptional cases in which drugs from Groups I and II should be used together are those which have often proved hardest to treat—where a strain of bacteria shows extreme resistance to a widely used antibiotic like streptomycin. But even in these cases laboratory tests have proved better than guesswork.

Even a single antibiotic can produce harmful (sometimes fatal) results if the doctor using it is not extremely alert. This was the case with Chloromycetin. The surest cure for typhoid fever, and one of the best drugs for Rocky Mountain spotted fever, brucellosis (undulant fever), typhus and some kinds of pneumonia, it had been given to about 8,000,000 patients since it was first marketed in 1949. Then it was found (TIME, July 14) that some patients who had been getting the drug had died of aplastic anemia (in which the bone marrow is unable to do its normal job of making red and white blood cells).

After a quick and thorough check by topnotch authorities, the Food & Drug Administration gave its verdict last week. Chloromycetin was connected with the deaths of at least 72 aplastic anemia victims. However, there are “serious and sometimes fatal diseases in which its use is necessary,” the FDA decided; therefore, doctors may still use it. But the manufacturers, Parke, Davis & Co., must warn doctors on the leaflet packed with every bottle that studies of the patient’s blood are essential if Chloromycetin is given for a long time. Further. “Chloromycetin should not be used indiscriminately or for minor infections.”