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Trimethoprim-sulfamethoxazole in chronic bronchitis
Canadian Medical Association Journal
|June 14, 1975
Summary
Trimethoprim-sulfamethoxazole (TMP-SMX) treatment reduced key bacterial pathogens in chronic obstructive pulmonary disease patients. The antibiotic combination achieved therapeutic levels in respiratory secretions, showing good tolerance and reduced sputum production.
Area of Science:
- Respiratory Medicine
- Clinical Pharmacology
- Infectious Diseases
Background:
- Chronic obstructive pulmonary disease (COPD) with chronic bronchitis often involves bacterial infections.
- Effective antibiotic penetration into tracheobronchial secretions is crucial for treatment success.
- Trimethoprim-sulfamethoxazole (TMP-SMX) is a commonly used antibiotic combination.
Purpose of the Study:
- To evaluate the efficacy of long-term trimethoprim-sulfamethoxazole (TMP-SMX) therapy in patients with COPD and chronic bronchitis.
- To determine the concentrations of TMP and SMX in tracheobronchial secretions (TBSE), saliva, and blood.
- To assess the impact of TMP-SMX on the microbial flora of the respiratory tract.
Main Methods:
- Aspiration of tracheobronchial secretions/exudates (TBSE) via fiberoptic bronchoscopy.
- Collection of TBSE, saliva, and blood during long-term TMP-SMX administration.
- Microbiological cultures (aerobic, anaerobic, fungi, mycoplasmas, viruses) of TBSE before and during treatment.
- Assay of drug content in TBSE, saliva, and blood.
Main Results:
- TMP-SMX treatment led to a decrease in the recovery of specific bacterial pathogens, including Hemophilus influenzae and Klebsiella pneumoniae.
- Therapeutic concentrations of both TMP and SMX were achieved in TBSE, indicating good drug penetration.
- TMP concentrations were higher in saliva than in serum.
- Little effect was observed on nonpathogenic upper respiratory tract bacteria.
- Patient tolerance was generally good, with some reporting reduced sputum production.
Conclusions:
- Long-term TMP-SMX therapy can effectively reduce the load of certain bacterial pathogens in the respiratory tract of COPD patients.
- The drug combination achieves sufficient concentrations in tracheobronchial secretions for potential synergistic activity against susceptible microorganisms.
- TMP-SMX is well-tolerated and may help alleviate symptoms like sputum production in this patient population.