PEDIATRICS Vol. 6 No. 2 August 1950, pp. 262-268
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PENICILLIN AND ITS EFFECT IN PRODUCING A PREDOMINANT GRAM-NEGATIVE BACILLARY FLORA IN UPPER RESPIRATORY TRACT OF CHILDREN

FREDERICK D. HAFFNER M.D.1, ERWIN NETER M.D.1, and MITCHELL I. RUBIN M.D.1

1 The Departments of Pediatrics and Bacteriology of the Children's Hospital and University of Buffalo, School of Medicine, Buffalo.

A study was carried out on 90 children to determine whether conversion to a gram-nagative bacillary flora of the nasopharynx and throat takes place during therapy with penicillin, either alone or in conjunction with sulfonamides, and to evaluate the influence of such a conversion on the course of the infection.

Following the demonstration of "conversion" in 22 selected cases, a change to a gram-negative bacillary flora was observed in an additional 30 out of 68 unselected children. The gram-negative bacilli encountered in this conversion group included members of the E. coli-A. aerogenes group, Ps. aeruginosa, A. fecalis and K. pneumoniae; these organisms became predominant in 23 out of the 30 cases of the unselected group. In 22 cases in this latter group the gram-negative bacillary flora was present prior to commencement of specific therapy; however, there was an increase in the number of these organisms in 13 instances. Conversion did not take place in 16 cases.

Vomiting per se was not responsible for the conversion since it occurred more frequently in the nonconverted group and vomiting was not a prominent feature of the converted patients.

Of 10 patients receiving penicillin as "aerosol," nine converted to a predominantly gram-negative bacillary flora.

The administration of sulfonamides in conjunction with penicillin did not materially lower the incidence of conversion.

Clinical evaluation of the patients showed that, on the average, the children who had "converted" had a more severe illness and one of longer duration than those of the nonconverted group.

Five patients of this group, all under 2 years of age, succumbed. Autopsy was performed in four and revealed the presence of gram-negative bacilli in the lung tissue of three of them.

The significance of these data is discussed.

Submitted on December 14, 1949




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