Systemic antibiotics started before operation have been found to give inadequate prophylaxis against postpneumonectomy empyema in our practice. Experimental work by others has suggested that combining this treatment with topical irrigation and intrapleural antibiotics would give improved results. We have adopted this suggestion and found it to give better prophylaxis where pneumonectomy is associated with high risk factors. The difficulty of anticipating these high risk cases, and fringe benefits of this combined technique, make this brief addition to operating routine reasonable in all cases.
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