Antibiotics and iatrogenic disease

THE ASSOCIATION of the term "iatrogenic disease" with the clinical use of antibiotics poses many problems. Physicians generally are familiar with most of the untoward reactions that may follow the use of antibiotics, and many excellent reviews of the subject are to be found in the literature. One cannot divorce the undesirable effects of antibiotics from the beneficial ones and, in this light, therapy becomes a calculated risk. If the probable discomforts or dangers outweigh the probable advantages, the cure may be worse than the disease, and one is then dealing with true iatrogenic disease. Probabilities of this kind cannot be assessed easily with antibiotics because reactions vary so much with type of drug, dose, course, method of giving and in different patients. Certain reports may be biased one way or the other because of personal prejudices or unusual series. Some ill effects are undoubtedly related to unwise, improper or careless use of the drug; others are not. So true incidences are not accurately known. Reactions where antibiotics are being used needlessly for trivial infections or for unnecessary prophybaxis are particularly deplorable while risks are justified when dealing with severe infections known to respond. Evaluation is difficult with infections of borderline severity and those prone to exceptionally severe secondary bacterial complications. Reactions may be mild or severe; none is negligible. Oxytetracycline, for example, is considered to be relatively harmless. Still, Jackson and his colleagues reported that 58% of patients with pneumonia showed untoward effects attributable to this antibiotic. Most reactions were mild, but the antibiotic was believed to have contributed in large measure to the fatal outcome in five of the seven patients who died in the 91 cases.