thiamphenicol-glycinate-acetylcysteinate and Respiratory-Tract-Infections

A total of 102 patients with recurrent upper respiratory tract infections underwent microbiological exploration with appropriate sampling and direct biopsies of the infected sites. Therapy was then started and on day 1 each patient received two intramuscular injections of thiamphenicol glycinate acetylcysteinate (TGA). From day 2 to 10 sequential therapy with the same drug was continued employing TGA administered by aerosol. All putative etiologic agents recovered were susceptible to thiamphenicol and only 24 demonstrated the ability to produce in vitro biofilms. The organisms comprised 10 Staphylococcus aureus, 6 Streptococcus pyogenes, 4 Streptococcus pneumoniae and 3 Haemophilus influenzae. Of the 24 subjects in whom biofilms were demonstrated to be present in vivo by Scanning Electron Microscopy, clinical and bacteriological cure was obtained in 21 cases (87.5%) following sequential therapy with TGA. Failures were considered to be persistent signs and symptoms at day 15 after initiation of treatment and lack of eradication of 3 S. aureus strains, despite their in vitro susceptibility to thiamphenicol. Very few adverse events attributable to TGA were reported in this cohort of patients. In no case was discontinuation of treatment deemed necessary by the attending physician.

Topics: Acetylcysteine; Adolescent; Adult; Aerosols; Aged; Anti-Bacterial Agents; Bacterial Physiological Phenomena; Biofilms; Drug Administration Routes; Drug Combinations; Expectorants; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Respiratory Tract Infections; Thiamphenicol; Treatment Outcome

After 30 years of therapeutic use, thiamphenicol glycinate acetylcysteinate (CAS 20192-91-0) is still widely employed in the treatment of upper and lower respiratory tract infections. This is due to its particular characteristic to exert at pulmonary level, either the antibacterial activity of thiamphenicol (CAS 15318-45-3) and the mucolytic activity of N-acetylcysteine (CAS 616-91-1). The aim of this study was to evaluate the present pattern of susceptibility of several clinical isolates to thiamphenicol and the interference of N-acetylcysteine on this parameter. The studies have been performed in vitro. Equimolar concentrations of N-acetylcysteine and even higher concentrations did not interfere with the antibacterial activity of thiamphenicol against Streptococcus pneumoniae, Streptococcus pyogenes and Haemophilus influenzae. The spectrum of activity of thiamphenicol was similar to that observed in the past and was superior to that of erythromycin and amoxicillin. The activity of thiamphenicol was greater than that of erythromycin against H. influenzae and streptococci and equivalent versus Branhamella catarrhalis. In comparison with amoxicillin the activity of thiamphenicol was higher against H. influenzae and B. catarrhalis and slightly lower against streptococci. The results demonstrate that thiamphenicol maintains its therapeutic value confirming the importance of thiamphenicol glycinate acetylcysteinate in the treatment of respiratory tract infections.

Topics: Acetylcysteine; Amoxicillin; Anti-Bacterial Agents; Bacteria; Chloramphenicol; Drug Combinations; Erythromycin; Microbial Sensitivity Tests; Penicillins; Respiratory Tract Infections; Thiamphenicol

Thiamphenicol glycinate acetylcysteinate (TGA), a molecular combination of an antibiotic and a mucolytic, is particularly indicated in the treatment of acute bronchopulmonary infections characterized by mucostasis. Our report is a synthesis of 9 clinical studies on TGA made in France between 1972 and 1976. These studies involved a total of 587 patients (475 adults and 112 children) with bacterial bronchopulmonary infections. Most of the patients were hospitalized, and none were affected by abnormal renal function or hematologic disorders. All received TGA per os or i.m. for an average of 7 days. The effects of TGA were evaluated clinically, radiologically, biologically and bacteriologically. The results of TGA treatment were assessed: - Favourable in 337 patients (58%), TGA mucolytic and antibiotic activity rapidly producing complete cures; - Useful in 160 patients (27%), TGA mucolytic and antibiotic activity producing slow cures; - Nil in 90 patients (15%), TGA producing no evidence of mucolytic and antibiotic activity. During treatment, various minor side effects were observed. In the case of two patients, treatment was not tolerated and therefore suspended. At the end of treatment, hypereosinophilia was observed in 5 patients and thrombocytopenia, anemia or inverted W.B.C. differential counts were observed in 22 patients, due to the presence of thiamphenicol glycinate in the molecule. These effects proved spontaneously reversible.

Topics: Acetylcysteine; Acute Disease; Adult; Anti-Bacterial Agents; Child; Drug Combinations; Expectorants; Humans; Mucus; Respiratory Tract Infections; Thiamphenicol