Antibiotics, sinusitis, and swine flu
For the past few months, the Giant supermarket chain has offered a free supply of certain antibiotics to customers with a doctor's prescription. As a family physician who is always explaining to patients why antibiotics are ineffective for the common cold, I wish that Giant executives had chosen a more useful class of drug to promote: drugs for high blood pressure or diabetes, for example. While doctors in past years (and, unfortunately, many doctors practicing today) handed out antibiotics like candy, recent scientific studies have shown how limited the medical uses of these drugs really are.
Take sinus infections, for example. They're sometimes caused by bacteria, so antibiotics should help, right? And some studies have in fact suggested that a few patients with laboratory-proven bacterial sinusitis may recover more quickly with antibiotics. But since tests for bacterial sinusitis are not available in primary care practices, it would be useful to identify clinical findings associated with a positive response to antibiotics. In a 2006 study published in the Annals of Family Medicine, Dr. An De Sutter and colleagues at Ghent University in Belgium studied the utility of clinical signs and symptoms of sinusitis and sinus x-rays for predicting duration of illness and the effect of amoxicillin, a commonly prescribed antibiotic.
The study enrolled 300 patients age 12 and older who visited their family physician with signs or symptoms suggestive of a sinus infection. Patients were randomized to take 10 days of either amoxicillin or a sugar pill. No clinical sign, symptom, or x-ray finding had any relationship to duration of illness or response to amoxicillin. The authors concluded that clinical information cannot be used to select patients who would benefit from antibiotic treatment. Consequently, they recommended symptomatic treatment (e.g. over-the-counter pain medication, nasal decongestants), rather than antibiotics, for patients with sinus infections. And so do I.
You may also wonder what you should do if you think you may have the H1N1 (also known as "pandemic" or "swine") flu. The Centers for Disease Control and Prevention has put together a nice web page that answers the most commonly asked questions. When an H1N1 flu vaccine is available next month, it is especially important that pregnant women and young children are at the head of the line, since they are the most likely to become very sick if they get the flu.
- The Flu Is A Virus!
It is winter and a lot of people are sick. Around here, and around the country, there are two big kinds of sick – one is mainly gastrointestinal disease with vomiting and diarrhea as the main symptoms, and the other upper respiratory infections with...
- "eggs Benedict" And "choosing Wisely": Often The Best Thing To Do Is Nothing
Years ago (OK, decades ago), when Woody Allen was a standup comic, he did a short, famous bit called “Eggs Benedict”. The narrator (let’s say “Woody”) is having pain in the chestal area (a great formulation which has long been popular in my...
- Antibiotics For Acute Appendicitis
Until recently, the most well-studied clinical questions about acute appendicitis have been how to efficiently diagnose it using the history and physical examination and laboratory and imaging tests. Once appendicitis was identified, the next step...
- How Long Does A Cough Last? (longer Than You'd Think)
At December's annual meeting of the North American Primary Care Research Group (NAPCRG), fellow American Family Physician editor Mark Ebell, MD, MS presented the findings from a study that provided an original take a seemingly simple question: how...
- Guest Blog: Morbidity
Dr. Ed Pullen is a family physician who practices at Sound Family Medicine in Puyallup, WA. The following piece is excerpted from a previously published post on his blog, DrPullen.com. ** When I was a first-year medical student, the term morbidity was...