1986 Volume 34 Issue 8 Pages 688-704
Thirty-three cases (Group A: Acute exacerbation of chronic respiratory tract infection, 13 cases. Group B: Pneumonia, 19 cases. Group C: Other, 1 case) of respiratory tract infections caused by P. aeruginosa were administrated the combination of TOB+CFS+FOM which was in vitro synergistic (FIC index≤0.5) against the fresh isolated P. aeruginosa, and clinical efficacy of this combination was evaluated.
1) The MICs 80 of TOB, CFS and FOM against 33 freshly isolated P. aeruginosa from the 33 cases were 4μg/ml, 32μg/ml and 128μg/ml, respectively. The ranges of FIC index of addition of FOM to TOB+CFS were 0.12-0.50.
2) Bacteriologically, 24 and 9 out of 33 cases were eradicated and reduced, respectively. Twentyfour (72.7%) out of 33 cases were eliminated. Clinical efficacies resulted in 14 excellent and 19 good cases. Clinical efficacies of both excellent and good were observed in all 33 cases. Concerning side effects, no severe one was observed.
3) After intravenous drip infusion of 1.0g or 2.0g CFS, 2.0g FOM for one hour and intramuscular administration of 60mg TOB, the serum concentration of each drug reached peak level at one hour in nine cases. The peak of serum concentration was 77.2±24.3 and 101.0±27.9±g/ml, respectively following 1.0g (3 cases) and 2.0g (6 cases) drip infusion of CFS. The peak of serum concentration was 130. 6± 44. 4μg/ml following 2.0g (9 cases) of FOM and 4.5±2.3μg/ml following 60mg (9 cases) of TOB. In Group A (4 cases) the peak of sputum concentrations of CFS, FOM and TOB were 3.4±2.4μg/ml, 7.3±4.0μg/ml and 0.9±0.2μg/ml, respectively, in Group B (3 cases) 3.8±3.5μg/ml, 10.6±7.3μg/ml and 1.5±0.9μg/ml, respectively.
4) In vitro time-kill studies, antibiotic combination showed stronger bactericidal effects against the isolated strains of P. aeruginosa than single drug.
We propose that measurements of MIC and FIC index may be a useful guide for treatment of respiratory tract infection caused by P. aeruginosa.
