John E. Kasik

Bronchial Secretion Levels of Amikacin

Amikacin was given to 14 noninfected men as three consecutive intramuscular injections (7.5 mg/kg) at 12-h intervals. Serum and bronchial secretion specimens were obtained at various times during flexible fiberoptic bronchoscopy after the final dose. Serum and bronchial secretion concentrations obtained between 1.5 and 2.0 h after the final dose ranged from 17 to 40 μg/ml and 2.3 to 8.4 μg/ml with a mean of 23.7 ± 2.9 and 5.23 ± 1.5 μg/ml, ±1 standard error of the mean, respectively. The highest bronchial secretion concentration in each subject correlated with the highest serum concentration (r = 0.83, P < 0.001), and all concurrent serum and bronchial secretion concentrations demonstrated a significant correlation (r = 0.82, P < 0.001). Clearance occurred at the same rate (half-life serum = 2.84 h; half-life of bronchial secretion = 2.60 h, P > 0.5). The mean bronchial secretion concentration of the 15 specimens obtained more than 7 h after the final dose was less than 1.0 μg/ml, with a range from 0.3 to 1.6 μg/ml. It is concluded that amikacin may achieve minimal inhibitory concentrations for many gram-negative bacteria in the bronchial secretions of noninfected patients 1 to 2 h after the final dose. However, levels fall below the reported minimal inhibitory concentrations against negative bacteria 6 to 7 h after the final dose. Furthermore, bronchial secretion levels may never reach the minimal inhibitory concentration against Pseudomonas aeruginosa.

β-Lactamase activity in slow-growing nonpigmented mycobacteria and their sensitivity to certain β-lactam antibiotics

It has been reported that certain nonpigmented, slow-growing mycobacteria do not have a constitutive beta-lactamase and are more sensitive to benzyl penicillin than M. tuberculosis. Thirty-nine isolates of these organisms, most of them belonging to the M. avium-intracellulare complex, were found to be sensitive to less than 10 micrograms of benzyl penicillin per ml in vitro. Approximately half of these isolates were inhibited by 1 microgram per ml. By contrast of 32 isolates of M. tuberculosis, only one was inhibited by 10 micrograms of benzyl penicillin. Sensitivity studies with cephalothin yielded similar results. Analysis of beta-lactamase activity in some of these species showed no activity, confirming earlier observations of this deficit.

Pulmonary disease due to Mycobacterium chelonei subspecies abscessus: A report of four cases

Four patients with upper and middle lobe pulmonary infiltrates and, in one case, cavities were studied. Their clinical presentation was compatible with mycobacteriosis. Multiple isolates of Mycobacterium chelonei, subspecies abscessus were obtained in high colony counts. The clinical course was variable and did not appear to be substantially effect by chemotherapy. This group represents the largest reported series to date.

The Efficacy of Inhaled Beclomethasone in Chronic Obstructive Airway Disease

The objective of this study was to examine the effectiveness of inhaled beclomethasone in the treatment of stable chronic obstructive airway disease (COAD). Eight patients completed a randomized, double‐blind, placebo‐controlled, crossover trial of inhaled beclomethasone and oral prednisone. Each patient received 3 treatment regimens given for 14 days: inhaled beclomethasone, prednisone, and placebo. There were no statistically significant differences in pulmonary function tests, oxygen cost diagram, or 12‐minute walking distance test among the regimens. The only improvement in arterial blood gasses was partial pressure of oxygen, which was negligibly increased during prednisone treatment compared with beclomethasone and with placebo (p <0.05). Evaluation of 95% confidence intervals indicated that clinically significant mean differences were unlikely with either beclomethasone or prednisone. Larger studies are required to determine if a responsive subgroup exists, and to determine if this form of therapy has a role in treatment of COAD.

Compliance with Medical Practice Guidelines: The Case of Home Oxygen

Standard and straight forward practice guidelines for administration of home oxygen therapy have been long established and widely accepted. Medical records for 418 patients prescribed home oxygen through hospital-based programs at seven Veterans Administration medical centers (VAMCs) were reviewed to determine compliance with practice guidelines at the time of initial and current prescriptions. Rates of appropriate prescription at some VAMCs were very high but were too low at other VAMCs, especially given the criterias simplicity and clarity. Practice guidelines should be implemented in conjunction with regular review mechanisms or other controls in place to ensure compliance.

Therapy of Chronic Obstructive Airways Disease

The most frequently employed measure in attempts to alleviate symptoms and improve the quality of life of patients with chronic obstructive airways disease (COAD) is to prescribe medications. However, COAD is largely an irreversible condition and no therapeutic intervention has been shown to be universally useful. Theophylline or corticosteroid are occasionally helpful but most patients will not benefit. Of the remaining options, only oxygen has been shown to be effective in selected patients and should be administered on a continuous basis. It is becoming increasingly evident that clinicians should be more discriminating when making therapeutic decisions for persons with COAD. Maintenance therapy with pharmacological agents should be entertained only after individually conducted therapeutic trials. Moreover, enormous costs can result from treating even a small fraction of the population estimated to have COAD.

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