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treated with antibiotics |
| The above headline is from the September 12, 2001 issue of Intelihealth. The first sentence of the report then goes on to say, "Primary-care doctors are still unnecessarily prescribing antibiotics to adults who come to their office complaining of a sore throat." This report was based on a study from a retrospective study carried out by researchers at Massachusetts General Hospital in Boston and at Stanford Center for Research in Disease Prevention in Palo Alto, Calif. The report was published in the Sept. 12, 2001, issue of the Journal Of The American Medical Association. The problem is that most adults don‘t develop the type of sore-throat infection that calls for antibiotics. This is because viruses, not bacteria, cause the most common type of sore throat infection in adults. This makes administering of antibiotics totally unnecessary in these cases. According to the study, doctors prescribed inappropriate antibiotics in 68 percent of visits for adults with sore throats. However, in spite of this, doctors continue to prescribe antibiotics at a rate between 73 and 78% of the cases of adult sore throat. Jeffrey A. Linder, M.D., of Massachusetts General Hospital in Boston and co author of the study said, “If you are going to see a doctor for a sore throat, the expectation should be to not receive an antibiotic. In 1999 we saw a decrease in the use of almost every class of antibiotics,” says Dr. Linder.“ That’s encouraging and may reflect that efforts already may be having some effect. But we need to keep an eye on it.” |
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ear infections questionable |
| The Southern California/RAND Evidence-based Practice Center (EPC) performed an analysis of clinical studies conducted on children four weeks to 18 years of age from 1964 through 1998, sponsored by the Agency for Healthcare Research and Quality (AHRQ). In this analysis the investigators found, a large percentage of children, nearly two-thirds of those studied, “with uncomplicated acute otitis media...recover from pain and fever within 24 hours of diagnosis without (antibiotic) treatment...and over 80% recover within 1 to 7 days.” The Evidence-based Practice Center estimates that over 5 million episodes of acute otitis media occur each year in the US at a cost of approximately $3 billion. In the United States it is routine to use antibiotics as a first treatment approach. This is in contrast to other countries, such as the Netherlands, where the standard practice is to use "watchful waiting" for one to two days after the onset of an ear infection in children over two years of age. In these countries antibiotic use is only called for if the infection fails to improve during that time. Because of the difference in antibiotic usage between the US and the Netherlands, the rate of bacterial resistance in the Netherlands is about 1 percent, compared with the US average of around 25 percent. This indicates that the US uses antibiotics more than other countries. Additionally, not only is antibiotic use possibly unwarranted, but questionable in their effectiveness. |
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Otitis Media (earaches) unproven |
| The results of a multinational study funded by the Agency for Health Care Policy and Research yielded surprising results. Eight international researchers from Britain, the Netherlands and the United States reported their findings after an exhaustive search of scientific literature on the use of antibiotics for children with Otitis Media. The paper produced by the group compared the differences in results in the United States and Britain, where the use of antibiotics is prevalent, with Iceland and the Netherlands where antibiotics are used very sparingly. According to the researchers otitis media is the, "most common reason for outpatient antimicrobial (antibiotic) use" in the U.S. They found that about 30 percent of children under the age of three receive antibiotic treatment for acute ear infections each year. This astounding number is in stark comparison to the Netherlands where antibiotic use is not even included in the initial routine treatment of otitis media. The paper created by these researchers asks and answers some hard questions concerning this issue. These questions and answers are quoted below. "Does treatment improve outcomes?" "Nevertheless, since results are mixed and no study found large differences between placebo and antimicrobial groups, we conclude that the benefit of routine antimicrobial use for otitis media, judged by either short or long-term outcomes, is unproved." "Does treatment prevent complications?" "Although preventing mastoiditis and meningitis is a rationale for antimicrobial treatment, little evidence exists that routine treatment is effective for this purpose." "Do children at high risk benefit from antimicrobials?" "No study has addressed whether antimicrobial treatment decreases the frequency of these (infections) in all or some of those with known risk factors." "What is the optimal type and duration of administration?" "In the nine country study, antimicrobials did not improve outcome at two months, and no differences in rates of recovery were found for either antimicrobial type or duration." "No compelling evidence" "After addressing these four questions, we conclude that existing research offers no compelling evidence that children with acute otitis media routinely given antimicrobials have a shorter duration of symptoms, fewer recurrences, or better long-term outcomes than those who do not receive them." "What is the effect on antimicrobial resistance?" "Antimicrobial use in children with otitis media results in the emergence of resistant organisms in those children and in the community. Although the organisms that cause otitis media are similar across countries, the Netherlands has a lower prevalence of resistant strains than other European countries." "What needs to be done?" "Research -- Placebo studies indicate that more than 80 percent of children with acute otitis media recover without antimicrobials." "Prevention of acute otitis media -- Sufficient information exists to support aggressive encouragement of breast feeding and avoidance of tobacco smoke. There is insufficient evidence of effectiveness to recommend pneumococcal vaccine." "Treatment of acute otitis media -- Clinicians should immediately reconsider the routine use of antimicrobials for children with otitis media and consider treating symptoms with analgesics and observation for lack of improvement." "Increasing worldwide resistance of bacteria to antimicrobial drugs is causing a crisis manifested by higher morbidity, mortality and costs." |
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complications in infants |
| In a report from the Centers for Disease Control (CDC) publicized by the Associated Press, it was reported that “Erythromycin has been strongly linked to pyloric stenosis”, an illness among newborns that blocks digestion and causes projectile vomiting.” This serious condition requires surgery to correct. The reports initiated at a Knoxville Tennessee hospital where 200 babies born in February 1999 were prescribed erythromycin after being exposed to whooping cough by a hospital worker. Seven of the children, all under three weeks old, became ill with pyloric stenosis. As a result the CDC is warning both doctors and patients to be aware of the potentially serious side effects of the antibiotic. It should be noted that newborns are also sometimes given erythromycin to treat chlamydia infections transmitted from their mother during childbirth. |
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