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Little cost for the individual, but we are paying the cost, BIG TIME,
now, in terms of resistant organisms. Pen-resistant Strep A, and of more
concern, is cephalosporin-resistant pneumococcus. We now have to treat
our meningitis patients with Vancomycin because of the pneumococcus;
guess what--now we are seeing Vancomycin-resistant enterococcus.
 
Please don't give unnecessary antibiotics!
 
 
Jim Chamberlain
Emergency Department
Children's Hospital
111 Michigan Ave, NW
Washington, DC 20010
(202) 884-3253 OFC
(202) 884-3573 FAX
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On Fri, 30 Jun 1995, DR MARTIN I HERMAN wrote:
 
> Regarding the issue of sputum color and infectious agents.
> I believe Ellen Wald at Pittsburg has said that te color of sputum
> especially nasal secretions does not correleate with the agent of
> infection. In fact after 2-3 days most secretions will have an influx
> of leucocytes, mast cells etc and will appear opague. Even so, I also
> am aware of a study published in the 70's that looked at Asthmatics
> with infiltrates noted on XRAY and determined that 96% of the time the
> infiltrates were due to a viral agent. Of course they relied on sputum
> cultures for bacteria as a way to rule in or out bacterial disease. Now
> given the technologies available in 1975, could they have missed a
> number of intracellular bacterial agents? I think so. Certainly
> legionella and mycoplasma for example are difficult to detect and there
> may be others that are causative that were not identifiable by the
> technology as it existed then or now. I personally favor instituting
> antibiotics when the Asthmatic has an infiltrate, a URI patient has not
> resolved after 5 days or has a history of recurrent OM. Are ear
> infections due to Viruses? Of course ~ 20% are but most practitioners I
> know will prescribe ABX when facing an opague drum or immobile drum.
> Just think of how many viral conjunctivitis cases get opthalmic
> antibiotics!
> On a practical note, I practiced for 6 years and was constantly amazed
> at the number of kids who were seen in my office for a simple URI who
> after being sent home on Naldecon or some decongestant retruned in 24-
> 48 hours with a suppurative OM. The parents get pretty upset because
> they are out the cost of another visit, time off work and a
> precription. Some  of my parents on Medicaid still worked in a factory
> and needed the income so the time lost from work was a factor. FOr the
> private payee, even more so! Parents pleaded with me to RX an
> antibiotic so that they could resume their struggle without taking
> additional time off work. I began to empathise with them and often did
> RX antibiotics when thay asked. I guess one could make the argument
> that even OM is self limited and that 86% ( British data) clear
> spontaneously, so why give antibiotics at all, but I'll bet most of you
> will still prescribe ABX for OM, right? What is the relative harm of
> giving the ABX for a viral illness,when weighed against the cost of a
> second visit and given that we are not perfect in our abilities to
> detect bacterial disease even when it is present?
>
> Food for thought only,,,,
>
> Regards, MIH
> Memphis Tn
>