RESUMEN
Lung amoxicillin levels were assessed in tissue obtained from 16 patients who underwent lung resection due to different pulmonary diseases. In this double-blind placebo controlled study patients were allocated to two groups in randomized order; one group received amoxicillin 1000 mg t.i.d. (n = 8) and the other amoxicillin 1000 mg + ambroxol 60 mg t.i.d. (n = 8). A trend towards higher antibiotic lung tissue levels was observed in patients who received the antibiotic together with the mucolytic agent. The ratio pulmonary tissue/serum amoxicillin levels reached a significant difference being higher in the amoxicillin plus ambroxol group than in the other one (0.411 +/- 0.04 vs 0.672 +/- 0.07; p less than 0.01), even if the amoxicillin plasma levels were lower. A possible effect of ambroxol on lung tissue penetration of amoxicillin is suggested and discussed.
Asunto(s)
Ambroxol/farmacología , Amoxicilina/farmacocinética , Bromhexina/análogos & derivados , Pulmón/metabolismo , Adulto , Anciano , Interacciones Farmacológicas , Femenino , Humanos , Pulmón/efectos de los fármacos , Masculino , Persona de Mediana Edad , Análisis de RegresiónRESUMEN
Amoxicillin levels were measured in bronchoalveolar lavage (BAL) fluid samples obtained from patients who after randomization were treated in double-blind fashion either with amoxicillin 1000 mg p.o.t.i.d. or with amoxicillin 1000 mg + ambroxol 60 mg p.o.t.i.d. Antibiotic levels were higher in the group receiving ambroxol (0.32 +/- 0.02 micrograms/ml; n = 8) than in the other one (0.19 +/- 0.02 micrograms/ml; n = 6). This difference was statistically significant (p less than 0.001). Comparisons of protein concentrations in BAL fluid samples and of amoxicillin plasma levels did not show significant differences in the two groups. These results seem to prove that ambroxol is able to increase the antibiotics concentration in the lungs, although the mechanism of action is still unclear. In addition it could be shown that the BAL technique is suitable for exploring the lung concentration of antibiotics.
Asunto(s)
Ambroxol/farmacología , Amoxicilina/farmacocinética , Bromhexina/análogos & derivados , Líquido del Lavado Bronquioalveolar/análisis , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Twenty-three patients with exacerbations of chronic bronchitis were divided in two groups in a randomized fashion receiving either amoxicillin 1500 mg/d (n = 13) or amoxicillin 1500 mg/d associated with the mucolytic drug ambroxol 90 mg/d (n = 10). The improvement in cough, expectoration difficulties and sputum purulence was statistically more evident and occurred earlier in the ambroxol + amoxicillin group than in the amoxicillin only group. Although amoxicillin plasma and sputum levels were similar in both groups, the differences in daily sputum volume, which was also statistically greater in patients receiving ambroxol, suggests that this drug favours the bronchial mucus clearance of the antibiotic which could be related to the more favourable clinical evolution. No changes were observed in lung function tests and blood gases.