I appreciate your comments.
On the issue of prophylaxis, I agree that there is little scientific evidence
that many areas of prophylaxis are really effective in preventing infection.
Many "protocols" are based on anectodes, bad studies, and the general "it
sounds like a good idea" approach. I guess I fall into the latter when it
comes to "high risk" dog bites. By high risk, I mean not that infection is
more likely, but that if an infection were to develop it might be more
serious than your run-of-the-mill cellulitis (ie, near the eye/buccal area,
on the hand, etc.).
As far as viral URI vs. sinusitis is concerned, I wholeheartedly agree with
what you stated. I am not arrogant enough to believe that I can always tell
the difference, so I too base my abx decisions on length of symptoms and
other not-so-scientific evidence (like mucous color). But what I was
objecting to was the practice of starting antibiotics at the first sign of a
cold, or even worse by phone in the middle of the night! That really steams
me, especially when that child comes to the ED the next day and I have to
make heads or tails out of a 15 month old with a fever who was started on
antibiotics without even an exam!
No, I am not a parent. The experience of having a sick child shouldn't
dictate a scientific position, however. If, on the other hand, you are
arguing that medicine needs to practical enough to abandon science (and
perhaps better judgement) to "treat" social concerns separate from illness
and health, you may be right. I am not wise enough (or arrogant enough) to
suggest that medicine should exist in a vacuum apart from social pressures.
However, if medicine (as a culture) continues in that direction, we will only
have ourselves to blame if things turn out bad for us in the long run.
Jeff Hoffman, M.D.