ABSTRACT The effect of three amoxycillin treatment regimens on purulent secretions of patients with
bronchiectasis has been studied. On the basis of information recorded on a diary card the patients
were divided into three groups, according to the usual nature of their secretions: seven who produced
mucoid sputum, which occasionally became purulent; seven whose secretions were usually
mucopurulent but occasionally purulent; and 19 whose secretions were persistently purulent.
Treatment with capsules of amoxycillin in a dosage of 250 mg three times a day resulted in clearance
of purulent secretions in patients of the mucoid group when they were treated for a clinical
exacerbation. The sputum remained clear in these patients for long periods before a further
exacerbation (median 6 l/2, range 1- 11 months). The mucopurulent-purulent group also responded
to this dosage but sputum purulence returned more rapidly (median 9, range 4-31 days). Only three
of the 19 (17%) patients with persistently purulent secretions showed a macroscopic response to this
dosage, whereas seven (60%) of 12 patients who received the higher dosage (3 g sachets twice a day)
responded. Among the failures, some responded to nebulised amoxycillin, suggesting that higher
levels of amoxycillin in secretions are required in these patients. Macroscopic clearance of purulent
secretions was finally achieved in most of the patients studied. The response was not always predictable
from the results of sputum culture. Clearance of secretions by antibiotics was also identified by
the patients, using a diary card score. Improvements in well being and in symptoms were noticed
even in the group who usually produced mucopurulent and purulent secretions even though they
appeared to be clinically stable before treatment.