Clinical and bacteriological efficacy and tolerability of FCE 22891 in patients with exacerbations of chronic obstructive pulmonary disease.

A beta-lactamase-stable antibiotic, the oral penem FCE 22891 (ritipenem acoxil), was investigated for use in exacerbations of chronic obstructive pulmonary disease (COPD). Thirteen of the 15 COPD patients had a proven lower respiratory tract infection. Symptom scores and forced expiratory volumes in 1 s significantly improved during therapy with FCE 22891 in combination with bronchodilators and intravenous corticosteroids. Conversion of representative sputum to nonrepresentative sputum or eradication of the original pathogen in representative sputum was effected in 12 patients. Resistance to FCE 22891 was observed in three cases with Haemophilus influenzae. Gastrointestinal disturbances, of which one was severe, were experienced by eight patients. Although FCE 22891 has some beneficial effect in exacerbations of COPD, there are reservations about its use because of adverse effects and potential inefficacy in the treatment of infection with H. influenzae.