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If renal impairment existseven usual oral or parenteral doses may lead to excessive systemic accumulation of the drug and possible liver toxicityUnder such conditionslower than usual total doses are indicated andif therapy is prolongedserum level determinations of the drug may be advisableThis hazard is of particular importance in the parenteral administration of tetracyclines to pregnant or postpartum patients with pyelonephritisWhen used under these circumstancesthe blood level should not exceed 15 mcg/ml and liver function tests should be made at frequent intervalsOther potentially hepatotoxic drugs should not be prescribed concomitantly.

The broad-spectrum effectiveness of Terramycin against both gram-positive and gram-negative organisms is enhanced by the particular effectiveness of polymyxin B against infections associated with gram-negative organismsespecially those due to Pseudomonas aeruginosawhere polymyxin B is the antibiotic of choiceIn additionthere is evidence to indicate that polymyxin B sulfate possesses some antifungal activityThe combined antibacterial effect of Terramycin plus polymyxin is at least additive andin many instancesan actual synergistic action is obtained.

The drug is tolerated by mouth and no serious side-reactions occurIn cases in which there is no organic or obstructive diseasethe response to Terramycin as a urinary antiseptic is prompt and effectiveIn several cases in which there was severe organic and obstructive disease and the organism was highly resistantthe course of the disease was not altered by giving Terramycin.

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