Aerosol antibiotic therapy in suppurative diseases of the lung and bronchi.

Inhalation therapy has become very popular both with physicians and the laity. While the use of antibiotics by nebulization is rather recent, the utilization of germicidal mists and therapeutic gases dates back many years. Those interested in a complete review of the historical background for aerosol therapy should read Segal’s excellent article on the subject.’ The original report on penicillin aerosolization was made by Bryson and his associates2 in 1944 and was an outgrowth of their work on the physical and biologic properties of aerosol for the Technical Division, office of the Chief, Chemical Warfare Service. Since then, stimulated by their findings, clinicians have made exhaustive trials with this method in pulmonary infection not only with penicillin but also with the sulfonamides, the sulfones and more recently with streptomycin. While this report Is limited to the results obtained in suppurative diseases of the lungs and bronchi by penicillin and streptomycin aerosolization, it should be noted that infectious asthma, pneumonia, laryngotracheobronchitis and pulmonary emphysema associated with infectious bronchitis or bronchiectasis were also thus treated. However, as is the case with reports of others, the number of patients in the latter group Is too small to warrant final evaluation. When one realizes the extensiveness of the inner surface of the lungs there is little wonder that effects similar to that of intravenous injection can be obtained by inhalation. In fact both Bryson3 and Barach45 and their associates have demonstrated In the experimental animal and in humans that a more uniform blood level of penicillin can be maintained by the inhalation method than by intermittent intravenous or intramuscular injections. Levine6 has gone even further and has satisfied himself that aerosol penicillin will effect improvement in bronchiectasis when other methods fail. That aerosolized materials when Inhaled penetrate the outer-