We studied the penetration of ampicillin-sulbactam in the alveolar lining fluid (ALF) of eight patients after intravenous administration of 2,000 mg of ampicillin and 1,000 mg of sulbactam three times daily over 30 min. Bronchoalveolar lavage was performed on day 3, 30 min after the end of the morning drug administration. The mean penetration ratios (i.e., the ratios of the concentrations in ALF versus those in serum) were 53% (standard error, 12%) and 611% (standard error 31%) for ampicillin and sulbactam, respectively. The concentration ratio of ampicilin versus sulbactam in serum was not significantly different from that in ALF. From a pharmacokinetic point of view, ampicillin-sulbactam is a good choice for treatment of infectious exacerbation of chronic obstructive pulmonary disease and community-acquired bacterial pneumonia, since the concentrations of both drugs in ALF exceed the MICs for the respiratory pathogens responsible.The clinical outcome of bacterial lower respiratory tract infections is a function of two, main factors: the efficacy of the host defense mechanisms and institution of appropriate antimicrobial therapy. The antimicrobial drug concentration at the site of infection is supposed to be a determinative element for effective antimicrobial therapy (2). This concentration should equal or exceed the MIC for the respiratory pathogen responsible (3,17,22). The final bioactive antibiotic concentrations in the bronchial wall and in secretions and in the alveolar lining fluid (ALF), which are the sites of infection in the lower respiratory tract, are the results of a complex and dynamic process (1, 2, 14).We evaluated the pharmacokinetic behavior of parenterally administered ampicillin-sulbactam in serum and studied the disposition of both drugs in ALF by using the bronchoalveolar lavage (BAL) technique. BAL has been used to study the chemical compositions of ALF in both normal and pathologic situations, such as interstitial lung disease and asthma. With this technique, the concentrations of immunoglobulins, complement components, surfactant, a2-macroglobulin, ao-antitrypsin, and several mediators have been determined (8,28). Only a few studies have used BAL for evaluation of the concentrations of drugs such as corticosteroids and antibiotics in ALF (5-7).Sulbactam is a semisynthetic P-lactamase inhibitor (10,20). In combination with ampicillin, it restores and extends the antibacterial activity of ampicillin to include some ,Blactamase-producing strains of bacteria, such as Haemophilus influenzae and Branhamella catarrhalis, that would otherwise be resistant (10,15,24). The penetration and ampicillin/sulbactam ratio in ALF have not been studied previously. MATERIALS AND METHODSPatients. Seven males and one female (average age, 71 years) with bacterial respiratory tract infections were invited to participate in the study after giving informed consent. All patients had chronic obstructive pulmonary disease and were hospitalized because of infectious exacerbation. Five * Corresponding author.patients...

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A national consensus conference, based on this review, concluded that health resources should be allocated to prevention and rehabilitation of intermittent claudication rather than to reimbursement of these products with doubtful efficacy.

1. A gas chromatographic method is described for the quantitative determination of the metabolites of papaverine in urine. 2. The urinary excretion of papaverine metabolites was studied in man. About 50% of the metabolites of papaverine are excreted in the urine within 48 h. 6-Desmethylpapaverine is the major metabolite in the urine. The metabolites are excreted almost completely in conjugated form.

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