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Volvulus of the Sigmoid Colon

Some press comments have suggested that transferable resistance may eventually deprive antibiotics of all therapeutic utility. However, this is not so. Resistance can be acquired in this way only in enterobacteria and some other exclusively Gram-negative bacilli. Chemotherapy is unnecessary for most of the intestinal infections seen in Britain. The outstanding danger is the possible loss of the efficacy of chloramphenicol for treating typhoid fever, though the Teesside epidemic perhaps illustrates another. Organisms such as Proteus, Pseudomonas, and Klebsiella may also acquire resistance, and they can cause a variety of infections, which may even become generalized in the newborn and in adults whose resistance is impaired by other disease. This is the extent of the problem, and, though it is limited, any possibility of remedying the situation must be welcomed. This can apparently come only from a reduction in the use of antibiotics in both livestock and man, and Anderson suggests that this should be the subject of an inquiry. Such an inquiry into the administration of antibiotics to livestock was officially proposed three years ago, and it is regrettable that the facts it was intended to ascertain are still not available. There are two sides to the question. First is the addition of small amounts of antibiotics to feeds to promote growth. The only permitted antibiotics for this purpose are penicillin and tetracyclines, and their use is restricted to poultry and pigs. We need to know whether these regulations are being observed-whether, for instance, feed supplementation is being practised illegally in calves, and whether the permitted quantities are being exceeded. Secondly, antibiotics and other drugs in great variety are given in larger doses for the immediate prophylaxis or actual treatment of enteritis. Among them are chloramphenicol, ampicillin, and neomycin, resistance to which must be prevented so far as possible. These drugs are supposed to be available only on veterinary prescription. Is their use under adequate control ? And have there been proper trials from which their benefits can be assessed ? These are questions which need answers. The veterinarian will naturally resent any interference with his freedom to prescribe, but he should be invited to consider whether he can do without chloramphenicol, since the preservation of sensitivity to this antibiotic is so vital to human health. The corollary to this, an inquiry into the use of antibiotics in the clinical field, would be a much larger undertaking. They are given to patients for a far greater variety of purposes and with varying degrees of benefit. Should the possible effect of tetracycline or ampicillin on the bowel flora deter doctors from prescribing them, for example, for mild infections of the respiratory tract ? The subject bristles with difficulties but it deserves serious study.