antibiotic abuse

Antibiotic Use in Pregnancy Linked to Allergy Related Symptoms in Child

A study of British children suggests that women who have an infection or take antibiotics during pregnancy are more likely to have a child with an allergy-related condition such as asthma, hay fever or eczema. Researchers at the University of Nottingham evaluated the medical records of nearly 25,000 British children and their mothers. The study found that children exposed to antibiotics in the womb had a higher risk of developing asthma, hay fever and eczema than did children whose mothers did not take the medication during pregnancy. Because a person's immune system develops while he or she is still in the womb, some experts speculate that factors that modify microbial exposure at this time may have a long-term effect on the risk of developing allergic disease.

Amer. J. Respiratory and Critical Care Med., 2002 (Sept 15);   166 (6):   827-832

Antibiotic Abuse Has Led to Increase in Ear Surgery

An increase in the number of acute otitis media (AOM) paediatric patients with suppurative complications at a tertiary care medical center appears to be related to a rise in incidence of resistant Streptococcus Pneumoniae isolates.

Cases needing surgery, they point out, are perceived to be on the increase in the era of antibiotic resistance.

The number of cases requiring surgical intervention was also seen to increase along with an increasing number of resistant Streptococcus Pneumoniae isolates.

Antibiotics not always necessary in treatment of otitis media

Well it always takes a crisis (resistant Streptococcus Pneumoniae) to conclude the obvious. Once again, another report comes up emphasizing the watch and wait approach.

"Children with otitis media who do not have a high temperature or vomiting during the first three days will most probably not benefit from antibiotics.

" Family doctors should wait for 24 to 48 hours before prescribing antibiotics for children with otitis as many will settle down on their own, analysis of a randomised controlled trial shows"

Hopefully the practitioners will step out of their paradigm and put the research to practical application.

Antibiotics Don't Help Sinusitis

Antibiotics do not help most children with acute sinusitis, according to a study in Pediatrics .  Investigators studied 180 youngsters, aged 1 to 18 years, with acute sinusitis. The children were divided into three treatment groups: 1) amoxicillin, 2) amoxicillin-clavulanate, or 3) placebo. Treatment lasted 14 days. Seventy-nine percent of the youngsters on amoxicillin improved after 14 days, as did 79% of those taking placebo pills and 81% of those on amoxicillin-clavulanate.

Most children with prolonged cold-like symptoms suggestive of acute sinus disease get better within three weeks, without antibiotic therapy," explains chief investigator, Jane Garbutt, MB, ChB. "Our study suggests that, for children with uncomplicated acute sinusitis, it makes sense to delay antibiotic treatment and watch carefully."

"Antibiotics are expensive and can cause side effects, most commonly diarrhea," Garbutt says. "Another concern is that they are an important factor in the emergence and spread of antibiotic-resistant bacteria."

Garbutt JM, Goldstein M, Gellman E, Shannon W, Littenberg B. //  A randomized, placebo-controlled trial of antimicrobial treatment for children with clinically diagnosed acute sinusitis . //  Pediatrics 2001 (Apr);   107 (4):   619

Antibiotics Usually Not Necessary for Ear Infection

For decades, chiropractors have expressed concern about the aggressive use of antibiotics in children with ear infection. Now, a study in the British Medical Journal validates that concern.

A total of 315 children, with acute otitis media were assigned to 1 of 2 cohorts: 1) a 72-hour waiting period with no antibiotic use or 2) immediate antibiotic intervention.  Findings showed that "immediate antibiotic prescription provided symptomatic benefit mainly after the first 24 hours, when symptoms were already resolving." Although children who were given antibiotics recovered an average of 1 day earlier than children who did not take the medication, no difference was seen in school absence or pain/distress scores. And, only 9% of children in the watchful waiting group developed diarrhea, compared with 19% of those taking antibiotics.

Overall, 77% of parents of children in the watchful waiting group expressed satisfaction with the care their youngsters received. In addition, these parents were less likely than parents of children who received antibiotics to predict that their youngsters would require antibiotics for subsequent ear infections.

Little P, Gould C, Williamson I, Moore M, Warner G, Dunleavey J. //  Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media . //  BMJ 2001 (Feb 10);   322 (7282):   336-342

Antibiotics may Hurt Discs

Antibiotic drugs may affect intervertebral disc health, according to a report published in the journal Spine.  As part of the study, scientists exposed cultured human annulus cells to four antibiotics commonly given to patients undergoing spinal surgery: cefazolin, gentamycin, cefamandole and vancomycin. After six hours, cells exposed to high concentrations of cefamandole or vancomycin showed decreased metabolism. After 48 hours, viability was lower in cells treated with all four drugs. Cells exposed to cefazolin and cefamandole also exhibited reduced proliferation.

"These findings show that high doses of antibiotics can have direct, deleterious effects on cultured disc cell survival, cell proliferation and metabolic rates," wrote the study's authors. "Studies such as the current investigation . . . show the importance of a greater understanding concerning antibiotic effects on disc cell proliferation and metabolism."

Hoelscher GL, Gruber HE, Coldham G, Grigsby JH, Hanley EN Jr //  Effects of very high antibiotic concentrations on human intervertebral disc cell proliferation, viability, and metabolism in vitro  // Spine 2000;   25 (15):  1871-1877

Antibiotics Not Necessary for Most Ear Infections

Researchers in the Netherlands report that children should not be given antibiotics when they initially present with ear infections. The study looked at 240 children, aged 6 months to 2 years, with acute otitis media. The children were prescribed either placebo or 40 mg/kg per day of amoxicillin. Youngsters who took amoxicillin were 13% less likely to exhibit persistent symptoms at day 4 - and were less likely to take pain medication - compared with children who were given placebo. However, there was no significant difference between the two groups in otoscopic findings, pain duration, or crying. In addition, tympanometric findings in both groups were similar at 6-week follow-up.  The study's authors concluded that, "This modest effect does not justify prescription of antibiotics at the first visit, provided close surveillance can be guaranteed."

Damoiseaux RAMJ, van Balen FAM, Hoes AW, Verheij TJM, de Melker RA //  Primary care based randomised, double blind trial of amoxicillin versus placebo for acute otitis media in children aged under 2 years //  BMJ 2000 (Feb 5);   320 (7231):350-354

Antibiotics may Cause Stomach Disorder in Newborns

Infants who are given the antibiotic erythromycin have increased odds of developing infantile hypertrophic pyloric stenosis, compared with infants who do not take antibiotics, according to the Centers for Disease Control and Prevention in Atlanta, Georgia.

Investigators looked at 157 babies less than 3 weeks of age who were treated with erythromycin after being exposed to whooping cough. A total of 5% of the newborns that took erythromycin developed hypertrophic pyloric stenosis, which was treated with surgery. This figure is dramatically higher than the average incidence of the disorder, which only 0.1% to 0.3%.

Hypertrophic pyloric stenosis in infants following pertussis prophylaxis with erythromycin
. //  MMWR Morb Mortal Wkly Rep 1999 (Dec 17);   48 (49):   1117-1120

Avoiding Antibiotics for Acute Otitis Media Reduces Community Load

The routine prescription of antibiotics for acute otitis media continues to be questioned.  In a recent report in the British Medical Journal (BMJ), Dr. Christopher Cates reports what happened in his practice one year after he and his partners decided not to prescribe antibiotics for children with an ear infection who were not systemi­cally ill.  Instead, they gave the parents a detailed handout and a deferred prescription.  Before the change, acute otitis media ac­counted for more than half of all their antibiotic prescriptions for children; afterwards it accounted for a third and their total antibiotic use for all childhood infections was reduced by a fifth.  Most parents welcomed the handout, and deferred prescriptions were often not redeemed.  The authors concluded "This approach may be useful in reducing the antibiotic load of children and in dealing with antimicro­bial resistance."

Cates C. //  An evidence based approach to reducing antibiotic use in children with acute otitis media: controlled before and after study  // BMJ 1999 (Mar 13); 318 (7185):715-716

Antibiotics Again Proven Ineffective for Ear Infections

January's Parenting magazine sites a watch and wait approach taken in the Netherlands when it comes to ear infections. Studies there have shown no risk from withholding them. In one study, out of all the children (4,000), only one child developed a complication-mastoiditis. Antibiotics were then administered and the infection subsided.

Most Acute Otitis Media Patients Recover Without Antibiotics

A study conducted by the Southern California/RAND Evidence-based Practice Center (EPC) and sponsored by the Agency for Healthcare Research and Quality reveals that nearly two-thirds of children with uncomplicated acute otitis media recover from pain and fever within 24 hours of diagnosis without treatment with antibiotics. And, over 80% recover within 1-7 days. When treated with antibiotics, up to 93% of children recover during the first week.

Investigators found no evidence that children with acute otitis media treated with amoxicillin fared any differently from those treated with newer, more aggressive antibiotics - which are more expensive and more likely to provoke side effects.

Clinical Evidence Shows Limited Effect of Antibiotic Treatment on Children With Acute Otitis Media. Press Release, August 9, 2000. Agency for Healthcare Research and Quality, Rockville, MD.

Study Looks at Over-Prescription of Antibiotics

A recent study highlights the cultural and economic forces spurring the over-prescription of antibiotic drugs, and the evolution of super-resistant microbes.  The report notes that antibiotics cost the U.S. about $15 billion per year. Extra hospital costs associated with drug-resistant hospital-acquired bacterial infections total at least $1.3 billion annually. Of 51 million visits to physicians for "colds," upper-respiratory infections and bronchitis, 50% to 66% resulted in an antibiotic prescription, even though these conditions usually do not require antibiotics. To explain this trend, the study's authors point to direct-to-consumer advertising, consumer demand, a medical training system that puts the least experienced doctors in charge of prescribing drugs and overloaded hospitals.

Avorn J, Solomon DH.//  Cultural and economic factors that (mis)shape antibiotic use: the nonpharmacologic basis of therapeutics  // Ann Intern Med 2000 (Jul 18);   133 (2):   128-135

Read more about the abuse of antibiotics:

The Antibiotic Warnings Page @ Chiro.Org
The Iatrogenic Disease Page @ Chiro.Org
Routine Use of Antibiotics for Otitis Media Unproven, Concludes International Researchers
Ear Infections and Antibiotics: What's the Reality?
The Post Antibiotic Age