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Comment: Chymopapain Evaluation

fluid intake in approximately equal proportions by history. Few adverse reactions occurred and only one adverse effect caused the need for the medication to be discontinued, i.e., one patient in the antibiotictreated group developed a rash. Our results support the conclusions of Alexander et aI., that despite the extensive use of antibiotics to acute exacerbations of COAD, beneficial outcome can not be clearly and conclusively demonstrated. Despite these data, antibiotics are used extensively in the treatment of acute exacerbations of COAD. In order to evaluate our results fully, several factors of the audit need to be discussed. First, the number of patients comprising the audit was small. A larger sample may demonstrate a difference. Second, outcome results were based on subjective evaluation. It is important to remember that patients and healthcare providers use symptomatic relief for monitoring positive outcome in acute exacerbations of chronic bronchitis. The use of open-ended, problem-specific questions with identical wording helped to minimize this problem. Third, documentation of compliance with drug regimens was not possible. No difference in drug compliance was found between treatment groups by historical evidence. It is clear that the need for a large, well-controlled clinical trial with clear-cut definitions and close patient follow-up in an ambulatory setting is needed to evaluate the appropriate use of antibiotics in acute exacerbations of COAD.