Side effects of antibiotics.

A review of the side effects of antibiotics in human patients is presented. At least three classes of untoward reactions may be distinguished: development of drug hypersensitivity, toxicological hazards, and microbial effects such as emergence of drug resistance. The intrinsic toxicitiies of the oldest discoveries, penicillin, penicillin and sulphonamides, have turned out to be very low for most animals as well as for man. These agents interfere with specific synthetic pathways in bacteria which are absent in mammals. The antibiotics discovered next (streptomycin and other amino-glycosides; chloramphenicol; tetracyclines) have all been shown to display, under certain circumstances various types of sometimes serious toxicities. As with thalidomide, the nature of their toxic effects had not been predicted by animal experiments. The present set of medically optimum antibiotics has its origin largely in substances with a long medical tradition. They represent the result of close cooperation of medical and scientific men of various disciplines. For the near future it seems unlikely that antimicrobial drugs will enter human and animal environments while yet tainted with any of the unforeseen side effects revealed in the past. Admirable work very recently carried out in the Institute of professor van Genderen shows that he never lost interest in the group of drugs that he so successfully explored when he was still on the staff of the institute where he started his career.