New guidelines may mean no more antibiotics

Sept 27, 2012

Christi Myers
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HOUSTON (KTRK) -- If you have fall allergies, prepare yourself. You're entering the season. And if your allergies tend to morph into sinus infections, those of you who go to the doctor for antibiotics may leave empty-handed.

Sinus infection sufferer Stephanie Santino said, "There were times where just literally sitting upright, that pain of holding your head upright was just really intense."

Santino describes the pain of her sinus infections. Typically, when it happened, she'd get an antibiotic from her doctor. But this year that is likely to change. 

Because doctors say, antibiotics often just don't work.
Sinus specialist Dr. Subinoy Das explained, "For the vast, vast majority of people we give antibiotics, it's not really providing the benefit that we would have hoped."

In fact, antibiotics for sinus infections may be making things worse. Up to 90 percent of sinus infections are caused by a virus and antibiotics don't help at all. For decades doctors prescribed them anyway and now we've grown some drug resistant bacteria.

"We are creating a race of super-bacteria for which we will not be able to treat," Dr. Das said.

So how do you treat sinus infections? Here are the new guidelines from infectious diseases experts: try an over-the-counter saltwater rinse. But do go to a doctor if your face swells, if you have fever, or your vision changes.

"Seek medical attention early but go with an open mind that I'm not going expecting an antibiotic," Dr. Das said.

Besides saltwater rinses you can buy at the pharmacy, some people with chronic problems get relief with sinus surgery, where passages are cleaned out and opened up. Talk to your pharmacist about other over-the-counter options that might give you relief.

HealthCheck

Reasons for inappropriate prescribing of antibiotics in a high-complexity pediatric hospital

Dec 2011

[Article in Spanish]

Ruvinsky S, Mónaco A, Pérez G, Taicz M, Inda L, Kijko I, Constanzo P, Bologna R.

Abstract

OBJECTIVE:

Determine the reasons for inappropriate prescription of antibiotics and identify opportunities to improve prescription of these drugs in pediatric patients hospitalized in intermediate and intensive care units.

METHODS:

A prospective, descriptive longitudinal study was conducted of pediatric patients in intermediate and intensive care units who received parenteral administration of antibiotics, with the exception of newborns, burn unit patients, and surgical prophylaxis patients. A univariate analysis and multiple logistic regression were performed.

RESULTS:

A total of 376 patients with a median of age of 50 months were studied (interquartile range [IQR] 14.5-127 months). Out of the total patients studied, 75% had one or more underlying conditions. A total of 40.6% of these patients had an oncologic pathology and 33.5% had neurological conditions. The remaining 25.9% had other underlying conditions. Antibiotic treatment was inappropriate in 35.6% of the patients studied (N = 134). In 73 (54.4%) of the 134 cases, inappropriate use was due to the type of antibiotic prescribed, the dose administered, or the treatment period.

The 61 (45.5%) remaining cases did not require antibiotic treatment. In the multivariate analysis, the risk factors for inappropriate use of antibiotics were: administration of ceftriaxone OR 2 (95% CI, 1.3-3.7; P = 0.02); acute lower respiratory tract infection OR 1.8 (95% CI, 1.1-3.3; P < 0.04); onset of fever of unknown origin in hospital inpatients OR 5.55 (95% CI, 2.5-12; P < 0.0001); and febrile neutropenia OR 0.3 (95% CI, 0.1-0.7; P = 0.009).

CONCLUSIONS:

Inappropriate use of antibiotics was less common in the clinical conditions that were well-characterized. Prescribing practices that could be improved were identified through the preparation and circulation of guidelines for antibiotic use in hospital inpatients.

SciElo