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In the specific field of respiratory tract infections, the presence of a purulent bronchial secretion containing a high amount of pathogenic bacteria, requires for the chosen antibiotic not only cover the spectrum or that it reaches high blood or pulmonary levels, but also that it can penetrate inside the mucus at concentration high enough to perform a sterilizing action, with the aim of preventing relapses.

There are data referring to an insufficient therapeutic activity of antibiotics, because they are not present at effective concentration in bronchial secretions, even they were present in considerable concentration in the serum.


So the basic elements of correct antibacterial therapy are:
Coverage the suspected pathogens.
Effective antibiotic concentration at the infection site.
Maintenance of antibiotic for a suitable time interval at the infection site.

On the basis of the frequency of the bacterial species responsible for the pathology involving the respiratory tract, mainly Gram-positive bacteria are responsible for the most respiratory tract infections.

ß-lactam antibiotics are regarded as the most suitable antibiotics for this kind of pathology, because of the satisfactory results obtained with them and their ease of use.

Comparison Between Antibiotic + Carbocisteine & Antibiotic Alone
Comparison Between Penetration of Antibiotic (Amoxicillin For Example ) Combined With Carbocisteine & Antibiotic Alone in Pathological Bronchial Secretion and Pulmonary Tissue.
This Study was Prepared by:
Institute of Chemotherapy, University of Milan.
INRCA Hospital, Casatenova Brianza, Como.
Department of Surgery, University of Milan.
Institute of Microbiology, University of Milan.
 
Summary:
  Two groups of patients with chronic bronchitis were treated with either amoxicillin ( 500 mg ) alone or in combination with carbocisteine (150 mg ) three times daily for five days.
 
Goal:
  To assess whether the combination allows higher antibiotic levels to be obtained in bronchial mucus than that obtained from amoxicillin alone
 
Procedures:
The levels of amoxicillin in the lung tissues, bronchial secretions, and plasma concentration were determined at first and fifth day.
The bacteriological data before treatment and at fifth day.
 
Results:
  The curve related to amoxicillin levels in bronchial mucus after administration of amoxicillin alone , as well as of the combination of amoxicillin and carbocisteine at first and fifth day of the treatment is shown below.

Amoxicillin levels in bronchial mucus at first and fifth day
after oral administration of amoxicillin (AMX 500 mg)
or amoxicillin (AMX 500 mg) + carbocisteine (150 mg) 3 times daily.
 
There is a statistically significant increasing in amoxicillin levels in bronchial mucus obtained with the combination of amoxicillin and carbocisteine in comparison with administration of amoxicillin alone.
This significant difference is also confirmed by the behavior of the AUC parameters related to the association, which gave significant different results from those obtained from amoxicillin alone:

Parameter Amoxicillin Amoxicillin + CMC
1st day 5th day 1st day 5th day
Peak 0.81 0.88 1.86 2.19
AUC 2.524 4.570 12.769 15.059
There are no statistically significant differences between Amoxicillin serum levels at the first and fifth day after administration of amoxicillin (AMX 500 mg) alone or amoxicillin + carbocisteine (150 mg ) three times daily.
In fact, combination of antibiotics with carbocisteine dose not enhance absorption of antibiotic in GIT. This is unlike combination of antibiotics with other mucolytics, where the antibiotics serum levels will increase due to the absorption enhancement of antibiotics as a result of an irritant action of the mucolytic agent on the gastrointestinal mucosa ( which is not a desirable phenomenon).

Clinical and bacteriological data obtained from patients affected by chronic bronchitis treated by mouth with amoxicillin ( 500 mg ) three times daily alone, and in combination with carbocisteine:

Isolated pathogen Amoxicillin (500 mg)
three times daily alone		 Amoxicillin (500 mg)
plus carbocisteine (150 mg)
three times daily
Bacterial change in
bronchial secretion		 Clinical
Outcome		 Bacterial change in
bronchial secretion		 Clinical
Outcome
Before After 5 Days Before After 5 Days
Strep.B-haemolyticus 4.2 X105 3.1 X101 Improved 5.3 X105 Sterile Recovered
Staph. aureus 3.8 X105 2.0 X101 Improved 3.8 X105 Sterile Recovered
Strept.pneumoniae (Female) 6.5 X105 Sterile Recovered 8.7 X105 Sterile Recovered
Haem. Influenzae 5.7 X105 3.5 X101 Improved 7.0 X105 Sterile Recovered
Strept. Viridans 4.6 X105 3.1 X102 Improved 6.5 X105 Sterile Recovered
Strept.pneumoniae (Male) 7.5 X105 Sterile Recovered 7.5 X105 Sterile Recovered
This finding indicate the presence of pharmacokinitic synergism between antibiotic (amoxicillin ) and carbocisteine, which allows antibiotic (amoxicillin )to penetrate more easily through the haematobronchial barrier . The association of antibiotic (amoxicillin ) and carbocisteine, determining an increase of quantitative levels of anti biotic in bronchial secretion ( also if it is purulent ) , performs a sterilizing action in a short time with significant therapeutic advantages.
 
Conculsion:
Mucosol provides synergistic effects when combined with antibiotics.
Mucosol improves the bronchial kinetics of antibiotics.
Mucosol allows easier penetration of antibiotics into pathological secretions.
Mucosol increases antibiotic level in the bronchial mucus.
Mucosol provides satisfactory clinical recovery in a short time.
Mucosol in combination with antibiotic eradicates completely the causative pathogens.
Mucosol in combination with antibiotic prvents relapses.
 
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