Treatment of lower respiratory tract infections with amoxycillin/clavulanic acid in adults.

Patients with lower respiratory tract infections [pneumonia (n = 16), bronchiectasis (n = 5) and acute exacerbations of chronic bronchitis (n = 44)] were treated daily with amoxycillin/clavulanic acid given either 1.2 g intravenously three times daily or 625 mg orally three times daily for 7-15 days. Symptoms, signs and sputum volume and colour were monitored daily. Chest X-ray, sputum culture and Gram-stain examinations were also carried out on days 1 and 5, and immediately after the end of the treatment. There was a clinical improvement, as indicated by the incidence of cough, dyspnoea and rales, and by sputum volume and colour in 90.8% of the patients. Microbiological improvement, as indicated by the complete elimination of sputum pathogens and pus cells, was achieved in the same proportion of patients (90.8%). In one patient, an adverse side-effect, diffuse exanthema, was noted. Amoxycillin/clavulanic acid possesses a high clinical and microbiological efficacy for lower respiratory tract infections.

Total effective time of the forced expirogram in disease: sources of error and a correction factor.

Effective time of the forced expirogram is a sensitive index for the detection of mild airways obstruction. However, there is evidence that this measurement is not superior to maximum flow rates in the lower half of the forced vital capacity or even FEV1 and FEV1% in some patients suffering from obstructive lung disease. Furthermore we noticed that in some patients with a decrease of the forced vital capacity caused by exacerbation of airways obstruction, the effective time was not appreciably changed. We concluded that this apparent disadvantage of the effective time is the result of the different forced vital capacities. To eliminate this error we transformed the forced expirogram to the equivalent curve that the patient would produce, if his forced vital capacity was equal to the predicted mean value for his age, sex, and height. The derived corrected total effective time seems to have increased sensitivity for detection of small changes in expirograms obtained from the same subject or from different subjects.

Partial effective times of the forced expiratory spirogram in health and mild airways obstruction.

The partial effective times of the expiratory spirogram were calculated in 80 normal non-smoking subjects aged from 20 to 69 years and in 30 patients aged from 30 to 58 years with chronic bronchitis. Of these patients, 28 had a normal FEV1/FVC ratio, while the other two had a low ratio. Partial effective times were calculated for 10% segments of the expired FVC from total lung capacity (0% FVC) to residual volume (100% FVC) and became progressively longer after 50% of the FVC had been expired in normal subjects. The elongation to the partial effective times was more pronounced with age. In the patients with simple chronic bronchitis (normal FEV1/FVC ratio) the partial effective times were longer than normal after 50% of the FVC had been expired and after 10% of the FVC had been expired in the two patients with chronic bronchitis and low FEV1/FVC ratio. The partial effective times of the forced expiratory spirogram, especially that at the 80--90% part of the FVC, seem to be very sensitive indices for the early detection of mild airways obstruction.