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July 11, 1980

Treatment of Anaerobic Pleuropulmonary and Soft-Tissue Infections-Reply

Author Affiliations

State University of New York Downstate Medical Center Brooklyn

JAMA. 1980;244(2):135. doi:10.1001/jama.1980.03310020016013

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In Reply.—  We want to thank Drs Covelli and Carpenter for their letter but believe that the significance of their experience in two patients is uncertain because of the scarcity of data.Unfortunately, we are not given any microbiological data, other than Gram's stains of sputum, on their cases. There are no cultural data with regard to aerobic or anaerobic organisms, either pretreatment or after "therapeutic failure," and consequently, no antimicrobial susceptibility data. Drs Covelli and Carpenter did not state what dosage of erythromycin was used, whether the patients were compliant in taking the medication, and what, if any, adjunctive therapeutic measures were used. It is well known that proper "pulmonary toilet," including postural drainage, is an important component of therapy for lung abscess. Progression to cavitation (case 1) does not necessarily imply treatment failure. As regards duration of therapy, their patients had courses of 14 days (case 1) and