A New Concept in the Treatment of Penicillin Reactions: Use of Penicillinase

Abstract

Severe reactions to penicillin have been reported sufficiently frequently to make their treatment a matter of importance. The present paper describes the use of penicillinase, an enzyme specific for the inactivation of penicillin. Patients with penicillin reactions were given penicillinase intramuscularly in single or multiple injections. The penicillinase apparently interferes with the antigen-antibody reaction causing the clinical manifestations in reactions to penicillin, by inactivating the antigen. Removal of the antigen alone could not be expected to reverse the damage already done. Forty-six patients with penicillin reactions were treated with penicillinase. Uniformly good results were achieved in 24 of these patients by means of penicillinase alone. The remaining 22 patients had received other therapy such as antihistamines or adrenocortical steroids; in 20 of these patients the favorable clinical response was attributed to the penicillinase. In two patients with a poor response, the penicillinase was not administered until weeks or months after the penicillin reaction had begun. There were no toxic reactions due to the penicillinase itself. It is concluded that penicillinase may be a valuable aid in the treatment of penicillin reactions. The successful treatment of acute renal insufficiency due to penicillin hypersensitivity by means of penicillinase, after adrenocortical steroids and antihistamines had been ineffective, is described in a case report in the Journal of the American Medical Association (167:1237, July 5, 1958).