[New and Current Concepts of Therapy in Non-CF Bronchiectasis]. / Non-CF-Bronchiektasen: Aktuelle therapeutische Entwicklungen.

Non-CF (NCF)-bronchiectasis is a syndrome of chronic inflammation leading to dilatation of airways and structural lung damage. Improvements of diagnostic procedures increase its perceived frequency. In Germany, recent data suggest a prevalence of 67/100 000.The outcome of therapeutic interventions is critically related to thorough diagnostic procedures. Genetical or immunological disorders (cystic fibrosis, alpha-1-AT deficiency, immune deficiency syndromes) require treatment options different from idiopathic NCF-bronchiectasis.Therapy is aimed at suppression of chronic inflammation and includes continuous mobilisation of secretions, immunomodulatory strategies and antibiotic therapy, whenever required. Surgical procedures are limited to specific complications (e. g. destroyed lung after airway obstruction, uncontrolled hemorrhage)Macrolides show a variety of immunological properties with favourable results in reduction of symptoms and frequency of exacerbations. Longtime tolerance is good, if individual risk factors are excluded.Antibiotics are given according to resistance patterns in acute exacerbations and in first-time detection of Pseudomonas aeruginosa and MRSA. Inhaled antibiotics for NCF-bronchiectasis will gain importance, depending on future studies. Currently, they are only used in individualized concepts of therapy.

Aspiration pneumonia and primary lung abscess: diagnosis and therapy of an aerobic or an anaerobic infection?

Pneumonia and primary lung abscesses may result from aspiration of infectious material from the oropharyngeal cavity and the upper respiratory tract. Most subjects suffer from an impaired mechanical or immunologic defense, for example alcoholism or dysphagia following stroke. The early course of the disease is uncharacteristic. Necrotizing pneumonia, pulmonary abscesses and the characteristic, foul-smelling, putrid discharge only occur 8-14 days after the initial aspiration event. Although common respiratory pathogens are frequently isolated from the lower airways of these patients, anaerobic bacteria play a pivotal role in cavitary lung disease following aspiration. Anaerobic coverage is therefore a requirement for an adequate antibiotic regimen, and antibacterial activity against common respiratory pathogens appears reasonable in most cases. Aminopenicillins/beta-lactamase inhibitors, newer fluoroquinolones with anaerobic activity (moxifloxacin) and clindamycin have demonstrated equal clinical efficacy in the treatment of aspiration pneumonia and primary lung abscess. Prolonged antibiotic therapy is required in cases with extensive damage of lung tissue. Since antibiotics can provide cure in 80-90% of cases, surgical procedures are limited to severe complications, such as pleural empyema. Cavitary lung disease has a broad differential diagnosis, including aspiration of sterile gastric content (Mendelson syndrome), staphylococcal pneumonia, tuberculosis, primary carcinoma of the lung, metastases and vasculitis.

Beau's lines in a patient treated with moxifloxacin for anaerobic pulmonary infection.

Onychotoxicity of fluoroquinolones is a rare event. Previously described cases of fluoroquinolone-related nail disorders were due to onychophototoxicity. This report presents a case of nail toxicity after treatment with moxifloxacin for anaerobic pulmonary infection, which has not been described previously. The appearance and circumstances of this nail disorder were consistent with the diagnosis of Beau's lines.

Single- and multiple-dose pharmacokinetics of oral moxifloxacin and clarithromycin, and concentrations in serum, saliva and faeces.

Moxifloxacin and clarithromycin are important antibacterial drugs in the treatment of community-acquired respiratory tract infections. In a double-blind, randomized, 2-period cross-over study the pharmacokinetics of moxifloxacin versus clarithromycin were determined after single and multiple doses in 12 healthy male volunteers. The concentrations of the antibiotics in serum, saliva and faeces were measured by validated high-performance liquid chromatographic methods. In serum, moxifloxacin exhibited a mean peak concentration of 3.1 +/- 0.6 mg/l after a time to peak concentration of 1.67 +/- 0.96 h on day 1, with a significant increase to 3.98 +/- 1.10 mg/l on day 7 (p < 0.05). The area under the curve-12 revealed a highly significant increase from 28.2 + 4.1 mg*h/l on day 1 to 39.5 +/- 6.6 mg*h/l on day 7 (p < 0.01). There were also significant differences in terminal half-life between day 1 and day 7 [10.6 h (range 9.0-12.8) vs 14.9 h (range 12.6-28.1); p < 0.01] and in mean residence time (15.1 +/- 1.9 vs 18.2 +/- 2.4 h; p < 0.01). The concentrations of moxifloxacin in saliva were well equilibrated with serum at a relatively constant saliva-serum ratio of about 0.8. Pharmacokinetic parameters of clarithromycin and its metabolite, 14-hydroxy-clarithromycin, were similar to previously published data. Accumulation was found. No serious adverse events were observed with either study drug.