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June 23, 1945

THE VALUE OF PENICILLIN IN THE TREATMENT OF EMPYEMA

JAMA. 1945;128(8):577-582. doi:10.1001/jama.1945.02860250023006
Abstract

Penicillin is almost nontoxic for man, yet it exerts a powerful antibacterial action against a wide variety of micro-organisms. Unlike the sulfonamides, penicillin is not inhibited by pus or other products of tissue destruction.1 When given intravenously or intramuscularly, it penetrates poorly into collections of pus, but if it is injected directly into an abscess it remains there for some time and may be found in considerable concentration as long as twenty-four to forty-eight hours after its injection.2 These unusual properties of penicillin have led some workers3 to treat empyema by aspiration of the pus, followed by instillation of penicillin. Theoretically, if this form of treatment is to be successful, the following conditions should prevail:

  1. The causative bacteria must be susceptible to penicillin.

  2. It must be possible for penicillin instilled in the empyema to contact all of the bacteria. Some empyemas are loculated so that

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