Penicillin aerosol therapy in bronchiectasis, lung abscess and chronic bronchitis

Abstract

Modifications in the technic of administering antibiotic aerosols are described. Penicillin blood levels obtained after inhalation are presented. A large amount of unused penicillin remains in the apparatus. Crystalline penicillin is the preparation of choice, since fewer local or systemic reactions have been encountered with its use. Physiological saline appears to be the most satisfactory diluent for penicillin at the present time. Attention is directed towards the importance of a high concentration of penicillin in the sputum, as well as an effective blood level, in therapy of suppurative bronchopulmonary disease. Following penicillin aerosol administration, sputum assays reveal high concentrations of the drug, whereas little or no penicillin is found in the sputum after intramuscular injection. Sputum cultures following courses of therapy with penicillin aerosol show disappearance of penicillin-sensitive grampositive organisms and predominance of gram-negative bacteria, usually of the coli-aerogenes group. Certain sulfonamide aerosols as well as streptomycin may be combined with penicillin in an attempt to eliminate gram-negative as well as grampositive bacteria from sputum cultures. Daily dosage of penicillin aerosol employed in treatment of bronchiectasis, lung abscess and chronic bronchitis varies generally from 150,000 to 500,000 units, although in a few instances 1,000,000 units are recommended. Clinical results of penicillin aerosol therapy in thirty-five patients with bronchiectasis, eight patients with lung abscess and sixteen patients with chronic bronchitis are tabulated, and four case reports with illustrative chest x-rays are presented. Of fifty-nine courses of therapy in thirty-five patients with bronchiectasis, there was marked improvement in fifteen, moderate in twenty-two, slight in fourteen and none in eight. Of seven courses of therapy in five patients with acute lung abscess, marked improvement occurred in four, slight in two and no improvement in one. Of four courses of therapy in three patients with chronic lung abscess, two resulted in marked improvement, one in slight improvement and one showed no change. Of twenty-four courses of therapy in sixteen patients with chronic bronchitis, improvement was marked in twelve, moderate in eight, slight in one and absent in three. Although a final appraisal of the benefit which may be expected from antibiotic aerosol therapy cannot be made at the present time, it is our conclusion that penicillin aerosol therapy constitutes an effective and practical technic which may be added to other forms of therapy in the management of patients with bronchopulmonary suppuration. The crystalline penicillin was supplied by Commercial Solvents Corporation, the sulfacetimide by Schering Corporation, and the oxygen by the Linde Air Products Company. The nebulizers employed in the investigation were supplied by the Vaponefrin Company. An additional fund was contributed by Mr. Cornelius Crane.