Tip of the Week Archive
This Week's Tip
Children with acute otitis media who may benefit from high dose amoxicillin (90 mg/kg/day) are those who attend daycare and/or have taken antibiotics in the previous three months.
Previous Tips
Five days of antibiotic therapy is recommended for the treatment of otitis media in children > 2 years.
A yellow/green nasal discharge often occurs 2-3 days after the start of a cold. This does not indicate a bacterial infection.
A recent report has shown that prescribing antibiotics for children with respiratory tract infections does not reduce the amount of time a physician spends with patients. It takes about 14 minutes per patient whether or not an antibiotic prescription is given. Arch Pediatr Adolesc Med 2005;159(12):1145-9.
Due to increasing antibiotic resistance, antibiotic prophylaxis is no longer recommended for the management of recurrent otitis media.
Current antimicrobial resistance patterns for Streptococcus pneumoniae and Haemophilus influenzae in Canada are available on line from the Canadian Bacterial Surveillance Network. See microbiology .mtsinai .on.ca/ research/ cbsn/
Penicillin, not amoxicillin, is the drug of choice for Group A Strep pharyngitis. Penicillin resistance in Group A Strep has never been reported.
Alcohol based hand sanitizers are efficacious and improve compliance with hand hygiene guidelines in health care settings. Effectiveness is related to the alcohol concentration and should be at least 60%. J Am Infect Control 2002;30(8):S1-46. Emerg Infect Dis 2006;12(3):527-9.
Ten percent of children will have a persistent effusion at three months post acute otitis media (AOM) and may be at risk of hearing loss. Evaluation of children three months post AOM is recommended.
Although both Mycoplasma pneumoniae and Chlamydophila pneumoniae have been implicated in acute exacerbations of chronic bronchitis, their role as pathogens in this condition has not been established.
Neither X-rays, CT scans nor MRI will distinguish between sinus abnormalities of viral upper respiratory tract infections and bacterial sinusitis and are not recommended in the management of acute sinusitis. J Otolaryngol 2002;31 Suppl 2:S2-14.
Advise your patients in high-risk groups to get a pneumococcal vaccine (see Bugs & Drugs antimicrobial reference).
Antibiotics may be of benefit in acute exacerbation of chronic bronchitis only if the patient has at least two of these three symptoms: increased sputum production, increased sputum purulence, increased shortness of breath.
In patients with acute bronchitis, 45% still have a cough at two weeks, and 25% still have a cough at three weeks.
Viral rhinosinusitis occurs up to 200 times more commonly than bacterial sinusitis.
Newer quinolone antibiotics (levofloxacin, moxifloxacin) have excellent activity against respiratory tract pathogens. However, because of their broad spectrum and potential for promoting increased resistance, these agents should be reserved for patients who have failed antibiotic therapy.
Depending on the season, up to 20% of people can carry Group A Strep. Throat swabs are not recommended for patients with sore throats associated with cold symptoms.
Acute bronchitis in children and adults is almost exclusively viral in etiology.
A population based study in Karachi, Pakistan has clearly demonstrated the benefits of handwashing in preventing pneumonia, diarrhea and impetigo among children and youth. Importantly, there was no benefit in using antibacterial soap over regular soap. Lancet 2005;366(9481): 225-33.
It is not possible to diagnose Group A Strep by clinical examination alone. A throat swab is recommended.
Amoxicillin retains the best activity of all oral beta lactam antibiotics against penicillin intermediate strains of Streptococcus pneumoniae.
Up to 80% of common infections are spread by hands. Handwashing is the best way to stop the spread of respiratory infections. All patients with colds and the flu should be advised of the importance of handwashing.
Fifty percent of children will have an effusion one month post acute otitis media. Antibiotics are not recommended.
The majority of upper respiratory tract infections are viral in etiology. A survey of Canadians in 2002 indicated that 53% of adults believed that antibiotics are effective against viruses.
A prolonged course of antibiotics (> 3 weeks) may be of value in chronic sinusitis. Repeated courses of antibiotics in chronic sinusitis are not usually beneficial.
Health Care Workers - protect yourself and your patients. Get the influenza vaccine. Remind your patients in high-risk groups to be vaccinated against the flu (see Bugs & Drugs antimicrobial reference).
