Thirty-eight patients with
bronchiectasis and daily expectoration of purulent sputum despite conventional
antibiotic courses were randomly allocated to receive a sachet of
amoxycillin (3 g) or matched placebo twice daily for 32 weeks in a double-blind study. Nine patients (four
amoxycillin, five placebo) were withdrawn from the study treatment; the response of the two patients (both on
amoxycillin) withdrawn within the first six weeks was not assessed. The pretreatment characteristics of the two groups were similar. Independent assessment of overall response based on patients' diary cards showed that a higher proportion improved in the
amoxycillin group (11 of 17) than in the placebo group (four of 19; p = 0.02). Patients in the
amoxycillin group spent significantly less time confined to bed and away from work during treatment. The frequency of exacerbations during the study treatment phase was similar in the two groups but they were less severe than before study treatment in the
amoxycillin group. There was a greater reduction in purulent sputum volume between exacerbations during the study treatment in the
amoxycillin group to 20 per cent of pretreatment volume than in the placebo group (88 per cent of pretreatment volume, p = 0.008), although the concentrations of Haemophilus spp. in sputum between exacerbations was similar in the two groups. Adverse effects experienced were minor except in one patient (
amoxycillin) withdrawn after developing a
rash and in six patients (three
amoxycillin, three placebo) who had diarrhoea lasting more than one week necessitating withdrawal of two patients (one
amoxycillin, one placebo) from study treatment. Sputum and stool cultures collected regularly during the study showed no important changes in the bacterial flora in either group. Prolonged higher-dose
antibiotic therapy in these patients with severe purulent
bronchiectasis significantly reduced the host (patient) inflammatory response to colonizing microorganisms and reduced morbidity.