Surgical treatment of bronchiectasis: ten-year survey.

Field: Medicine (Health Sciences)

MEDICAL JOURNALtwo pathogens from the sputum during treatment, though they often reappeared before the patient left hospital.However, this alteration in the flora of the bronchi appears to have conferred little additional benefit on patients already receiving routine ward treatment.This routine, with breathing exercises, postural drainage, bronchodilator sprays, and early ambulation, was applied with as much enthusiasm and frequency as was humanly possible.There was an atmosphere of active treatment for an often neglected illness which must have contributed psychologically and allowed the earlier discharge of patients.Our results indicate that ampicillin reduces the frequency of early relapses even if it does not affect the ultimate prognosis of the acute illness.The frequency of relapses seemed to be reduced only in those patients with H. influenzae in their sputum on admission.Unfortunately this test takes time, and is especially unreliable when the patient has received antibiotics before admission.If treatment is to be started straightaway a different method of selecting which patients need antibiotic treatment is needed.Antibiotic therapy is not without its hazards, both to the patient and to other patients around him in the hospitalenvironment.Broad-spectrum antibiotics are particularly apt to encourage cross-colonization by " hospital " antibiotic-resistant bacteria.New methods are needed so that the patient who will really benefit from antibiotic therapy can be identified as soon as he reaches the ward.The rest of the bronchitic patients should not receive antibiotics while in hospital. SummaryThe value of ampicillin in the hospital treatment of exacerba- tions of chronic bronchitis has been assessed in a double-blind trial.Twenty-eight pairs of patients were included in a sequential trial in which all patients were treated intensively with broncho-dilator drugs and physiotherapy.One member of each pair received bacteriologically effective doses of ampicillin for seven days, while the other member of the pair received placebo.Sequential analysis of the results showed no conclusive evidence that the ampicillin was beneficial.Ampicillin did not shorten the length of the patients' stay in hospital.In those patients whose sputum cultured Haemophilus influenzae on admission there was a reduction in the frequency of relapses while the patient was still in hospital.There was no evidence that any such improvement caused by the ampicillin persisted after the patient was discharged from hospital.We are grateful to Dr. J. A. Fisher, who acted as the indepen- dent observer.We are indebted to the Northern Ireland Hospitals Authority for making the beds available which made this trial possible, and for funds granted through their Medical Education and Research Committee.The trial could not have been run without the active co-operation of the staff of the Belfast City Hospital, and in particular Ward Sisters Harrison and McCully, Miss Kelso, of the Physiotherapy Department, and Mr. Coulter, chief pharma- cist.Statistical advice was obtained from Dr. J. D. Merrett, of the