DIAGNOSTIC AND THERAPEUTIC STRATEGIES IN THE FACE OF EXACERBATION IN CHRONIC-BRONCHITIS - DOMICILIARY PRACTICE

The consensus conference convened by the French Language Society for I nfectious Disease at Lille in 1991 stressed the fact that two germs we re most often the cause of exacerbation in chronic bronchitis (Strepto coccus pneumoniae and Haemophilus influenzae) and that antibiotic ther apy was the ''safe solution'' and that the first intention treatment s hould be either penicillin A, a first generation cephalosporine or a m acrolide for the first 8-10 days. A chest x-ray was recommended if the re was the slightest doubt about co-existing parenchymal disease with a re-evaluation around the 7th day and a prescription of penicillin A plus a beta-lactamase inhibitor or a second or third generation cephal osporine in case of failure. The aim of this study was to assess the d iagnostic and therapeutic attitudes of general practitioners when face d with exacerbation in chronic bronchitis in an adult of 60 without se vere signs and to find out the antibiotic of first choice and also the antibiotic to be used if the first treatment failed. One hundred doct ors were drawn at random from a list of general practitioners in Borde aux. They were requested to reply to a questionnaire on the strategy o f first choice antibiotic and the means of reassessment of the treatme nt after it had been instituted and the strategy used when faced with a patient who did not improve after the initial treatment. Eighty four doctors responded to the questionnaire and the following facts can be gathered: the diagnosis of exacerbation in chronic bronchitis was ess entially based on changes in expectorated sputum; penicillin A with be ta-Lactamase inhibitors were the mast frequently prescribed antibiotic of first choice in exacerbation of chronic bronchitis; for the second choice antibiotics the situation was more confused; the co-prescripti on of mucolytics and anti-inflammatory drugs was almost standard; syst emic steroids were prescribed by 50% of general practitioners; all pre scriptions, including a sickness certificate, were made for a period o f 7-10 days. It can be concluded that for general practitioners faced with to chronic bronchitis without severe signs, their attitude was ve ry close to those recommended by the consensus conference. However, th ey tended to consider respiratory failure as a major risk factor and u se, as first choise, antibiotics that are recommended as second choice straight away.