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. http://www.ahrq.gov/news/press/pr2000/otitispr.htm
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