January 6, 1975

High-Dose Penicillin

Author Affiliations

University of California San Francisco

JAMA. 1975;231(1):23. doi:10.1001/jama.1975.03240130017007

To the Editor.—  The recent article in The Journal, "High-Dose Penicillin Therapy and Pneumococcal Pneumonia" by Brewin et al (230:409, 1974), demonstrated clearly that high doses of penicillin G had no advantage in the treatment of their series of severely ill patients. There is one point in the discussion, however, with which exception must be taken. The authors state:Human beings are able to tolerate massive quantities of penicillin. The dosage of penicillin is not limited by direct toxic effects of the drug but by the emergence of pathogenic organisms... where normal flora are usually present.Penicillin toxicity is by no means rare in patients receiving dosages of 20 million units of penicillin G per day. It is more likely to occur in patients with renal insufficiency, but the dosage may be toxic in patients with normal renal function. There is a useful review of the subject by Raichle and