Combined use of aztreonam and clindamycin in the treatment of respiratory infections associated with lung cancer

We carried out a multi-institutional ‘prospective’ non-randomized trial to test the value of the combined use of aztreonam (AZT) and clindamycin (CLDM) as empirical chemotherapy in lung cancer patients for whom respiratory infections are considered to be one of the major prognostic factors. Forty-four patients were entered into the trial. The 41 cases which were able to be evaluated consisted of 34 males and 7 females, and cytologically there were 19 epidermoid carcinomas, 14 adenocarcinomas, 5 small cell carcinomas, 2 large cell carcinomas and 1 undetermined cell type. The patients were treated with 4 g/day of AZT and 1,200–2,400 mg/day of CLDM for at least 5 days. There were 1 excellent and 17 good responders with an overall efficacy rate of 46%. The cases with adenocarcinoma, stage IV, or PS 3–4 tended to be less responsive to the treatment. Out of 9 strains able to be evaluated for microbiological efficacy, 2 were eliminated, 1 was diminished, 3 were substituted by the other strains, and 3 were unchanged. Adverse effects of the treatment were minimal and transient. There were 3 cases with skin eruption and one case with anorexia. Two cases showed a transient elevation of serum GOT and GPT. The authors have already reported clinical efficacy rates of 40–60% for various combination therapies of β lactams and aminoglycosides for the respiratory infections associated with the lung cancer. The present study showed an efficacy rate comparable with those results. We conclude that combination of AZT and CLDM is moderately effective and one of the options in the treatment of those infectious diseases.