Absorption and Excretion of Penicillin injected into the Muscles of Patients with Diabetes Mellitus

Abstract

THE observation that two patients with sub-acute bacterial endocarditis due to alpha-streptococci highly sensitive to penicillin in vitro failed to respond to administration of six million units of the drug a day led to investigations which revealed low peak blood-levels and abnormal urinary excretion of the antibiotic in both. When the dose of penicillin was increased to a quantity greatly in excess of that suggested by the test-tube sensitivity of the organisms, favourable clinical response followed promptly. Other than the endocarditis, the only finding common to both individuals was the presence of diabetes mellitus. Since a review of published information concerning the pharmacology of penicillin^1–4 revealed no data indicating any abnormalities related to the diabetic state, it was decided to investigate this problem.