Medical Forum / Diseases and Disorders / Sinusitis / July 2006
Publication on the management of acute bacterial sinusitis
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Susan - 12 Jul 2006 20:44 GMT http://www.medscape.com/viewarticle/537244_1
"In clinical practice, effective management of ABRS, particularly maxillary sinusitis, poses significant challenges. Diagnosis of ABRS is often difficult because its symptoms are very similar to those of a viral infection, and there are no rapid, simple and reliable diagnostic tests to determine the presence of a bacterial infection. The major challenge in the treatment of ABRS is the selection of appropriate antimicrobial therapy, which should be guided by local patterns of resistance, adequate activity against pathogens commonly associated with ABRS and pharmacodynamic potency. The goals of this review are to discuss diagnostic and treatment challenges and to describe the approaches to these issues recommended by various national guidelines for management of ABRS in North America and Europe."
Susan
judy.n - 13 Jul 2006 15:13 GMT I'll check out the article. One of the problems in practice is the trend to try and avoid antibiotics. It's worthwhile, but can be taken to extremes. I saw a woman yesterday who was refused antibiotics for a protracted sinusitis because she was a smoker. I once researched the gold standard "Cochrane collaborative" position paper on antibiotics for sinusitis: they reviewed over 3000 studies and discarded all but 3! They used maxillary sinus puncture or xrays as the diagnostic criteria. So, the unchallenged experts of evidence, concluded that there was insufficient evidence to conclude that antibiotics are useful in sinusitis. I wrote a brief article on it for a family practice journal, and referenced the ENT guidelines, which are clinical. It's good that they update them periodically. I don't want to over-prescribe antibiotics, and the less the better, but the trend to withhold them despite clinical evidence of sinusitis is concerning. I"m sure everyone who posts here wouldn't want to take antibiotics unless they needed them, but sometimes you do. Judy
> x-no-archive: yes > [quoted text clipped - 14 lines] > > Susan Susan - 13 Jul 2006 18:16 GMT > I don't want to over-prescribe antibiotics, and the less the better, > but the trend to withhold them despite clinical evidence of sinusitis > is concerning. > I"m sure everyone who posts here wouldn't want to take antibiotics > unless they needed them, but sometimes you do. Ya know, Judy, with 80% of all antibiotics manufactured in the U.S. being dumped into animal feedlots and sprayed on produce, I don't think keeping abx out of the hands of suffering patients offers the biggest bang for our prevention buck.
I recall a NY Times article in the 1980s about how our abx were about to become useless due to agricultural practices. :-/
Susan
judy.n - 14 Jul 2006 01:31 GMT Susan, I completely agree." Fast Food Nation" was a horrifying revelation. I think the withholding antibiotics trend has some merit: very busy doctors just prescribe for colds to get patients out the door quicker, but I've seen some horrible situations where people who truly need antibiotics are denied them. When quinilone resistant salmonella develops in treated chickens, I don't think a sinus sufferer has caused this by using medications when truly needed. Medicine is trendy, and some people adopt the trends too broadly without questioning or realizing every person/patient is unique. I've tried to buy organic as much as possible to discourage the feedlot method of producing food. Judy
> x-no-archive: yes > [quoted text clipped - 13 lines] > > Susan Susan - 14 Jul 2006 01:38 GMT > Susan, I completely agree." Fast Food Nation" was a horrifying > revelation. I haven't seen it; I thought it was about obesity/health effects?
> I think the withholding antibiotics trend has some merit: > very busy doctors just prescribe for colds to get patients out the door > quicker, but I've seen some horrible situations where people who truly > need antibiotics are denied them. I certainly think rx'ing of abx for no reason should be avoided. I just think it's a drop in the bucket as long as streptomycin is being sprayed on produce.
> When quinilone resistant salmonella develops in treated chickens, I > don't think a sinus sufferer has caused this by using medications when [quoted text clipped - 3 lines] > I've tried to buy organic as much as possible to discourage the > feedlot method of producing food. Buying organic won't help you avoid feedlot production, unfortunately, though it will reduce certain residues. Buying grass fed animal foods or range fed will. See the recent NY Times magazine article on Walmart and organic foods.
A cow fed organic grains is still sickly and still produces an unheealthy product compared to a cow grazing on grass.
Susan
judy.n - 14 Jul 2006 13:38 GMT Susan, "Fast Food Nation" was a book, published about 4-5 years ago now. "Supersize Me" was a movie, where a man only ate at fast food restaurants for a month, and got ill. My 18 year old daughter has struggled with migraines for the last two years, and in the process of modifying her diet, we've begun to shop at Whole Foods to minimize additives and possible food triggers. She also has been fighting a prolonged sinus infection, but it's often tough to sort out her symptoms, as they overlap ("sinus pain" is often her migraine.) She's on a prophylactic agent: nortriptyline, and her ENT started low dose zithromax to try and suppress the sinusitis episodes as she's headed off to college/dorm life in a couple of months. She was actually hospitalized for her migraines in junior year: she has pronounced migraine associated vertigo at times. An interesting note: I read an article on how the "valsalva maneuver"--baring down, can trigger migraines, and since graduation, her saxophone hasn't been played, and she's not symptom-free, but improved. (Also, the crazy noise level of the jazz band couldn't have helped.) It makes me crazy to see the adds for "corn fed beef": they're ruminants, they weren't meant to be fed corn, it makes them ill and then they need antibiotics. We have an older horse, and he's healthiest when he's only on grass/hay with minimal grain. They're not meant to eat that stuff. You are right, the corn lobby is harmful in many ways. I'll checky out Walmart and organic foods: it seems an oxymoron to mention the two in the same sentence. Back to your original post: it let me right in, but I have a subscription. Thanks for all the excellent information. Judy
> x-no-archive: yes > [quoted text clipped - 29 lines] > > Susan Susan - 14 Jul 2006 14:11 GMT > Susan, "Fast Food Nation" was a book, published about 4-5 years ago > now. "Supersize Me" was a movie, where a man only ate at fast food > restaurants for a month, and got ill. Oops, my bad. Haven't read nor seen either. :-/ I've been paying attention to this stuff in the biomedical literature for several years, after having to diagnose my own PCOS, insulin resistance and apparently longstanding type 2 DM. The stuff I've learned about disease prevention and health maintenance is all in direct opposition to what our national authorities put out there. As I said, I thought this was unique to the politics of tick borne diseases, where our CDC and NIH and academics are behaving in ways I consider criminally negligent. It seems to be going around.
> My 18 year old daughter has struggled with migraines for the last two > years, and in the process of modifying her diet, we've begun to shop at [quoted text clipped - 6 lines] > actually hospitalized for her migraines in junior year: she has > pronounced migraine associated vertigo at times.
> An interesting note: I read an article on how the "valsalva > maneuver"--baring down, can trigger migraines, and since graduation, > her saxophone hasn't been played, and she's not symptom-free, but > improved. (Also, the crazy noise level of the jazz band couldn't have > helped.) We all have to be detectives, don't we? There are so many potential triggers, and who can say each of us doesn't have more than one? Years ago, on a very low fat diet, I ate red Twizzlers for treats. Til I figured out they made me wake with a burning stomach, searing migraine with vomiting every time. I learned that red dye #2 (or #5? #40? I think it's #2) triggers migraine in lots of folks. For some women, hormones are a trigger. In my case, Lyme and other TBDs seemed to be a cause, too, as my frequent migraines went away with high dose oral doxy, and never came back (they were weekly at that point) til I developed severe sinusitis. 3 triggers for me that I know of, with different patterns and locations of pain.
> It makes me crazy to see the adds for "corn fed beef": they're > ruminants, they weren't meant to be fed corn, it makes them ill and > then they need antibiotics. Yes, but feed them organically *grown* corn, and you can mislead folks into thinking the product is healthier. :-/
In fact, grass fed beef is very heart healthy, grain fed beef is higher in arachidonic acid, omega 6, saturates and overall fat, low in CLA...
> We have an older horse, and he's healthiest > when he's only on grass/hay with minimal grain. They're not meant to > eat that stuff. > You are right, the corn lobby is harmful in many ways. > I'll checky out Walmart and organic foods: it seems an oxymoron to > mention the two in the same sentence. It is! They're giving organic a bad name; using feedlot practices to produce unhealthy products that meet the criteria to be called organic.
:-/
> Back to your original post: it let me right in, but I have a > subscription. > Thanks for all the excellent information. Thank you for all of yours, anecdotal, professional and with terrific citations!
Susan
Murray Grossan - 16 Jul 2006 19:10 GMT On 7/13/06 5:31 PM, in article 1152837116.086958.261690@b28g2000cwb.googlegroups.com, "judy.n"
> Susan, I completely agree." Fast Food Nation" was a horrifying > revelation. I think the withholding antibiotics trend has some merit: [quoted text clipped - 26 lines] >> >> Susan You are also invited to join ZAAP Zaap Antibiotic Abuse Personally at http://www.hydromedonline.com/zaaphmol.html to help reduce current antibiotic abuse. No dues or meetings, just spread the word about not abusing antibiotics
It takes 5 minutes to write an Rx for an antibiotic and leave time for a beer break. It takes 25 minutes to TRY to convince a patient not to take an antibiotic! And guess what, at the reception desk she asks for an appointment to see another doctor in the group! It is your neighbour that gets the 20 day Rx and stops in 5 days because he feels better that causes the resistant bugs to flourish in your area, so spreading the word locally can have a significant effect.
Susan - 17 Jul 2006 23:42 GMT > You are also invited to join ZAAP Zaap Antibiotic Abuse Personally at > http://www.hydromedonline.com/zaaphmol.html to help reduce current [quoted text clipped - 9 lines] > feels better that causes the resistant bugs to flourish in your area, so > spreading the word locally can have a significant effect. With 80% of all antibiotics manufactured in this country ending up in feedlots and on produce, ZAAP doesn't strike me as having much of a shot at reducing abx resistance.
It's not even addressed on that page.
Susan
judy.n - 18 Jul 2006 14:33 GMT As a primary care physician: I take offense at the comment that it "takes 5 minutes to write for an antibiotic and have time for a beer break." I got home hours late last night, as usual. I wrote no antibiotic prescriptions. It's an over-simplification and insulting to make those type of comments. Perhaps, several years ago, before the concern about increased bacterial resistance and antibiotic over-prescribing were initially raised, this initiative had some merit. Some infections require antibiotics: I've personally seen a child be denied antibiotics for a cellulitis, who ultimately ended up hospitalized within a day with a severe infection, other patients denied antibiotics who ended up with pneumonia. It's a judgement call, not a simple denial. Even the studies of antibiotics and bronchitis state that a subset of patients benefit from them. I take care of kids and adults. As I see fewer children, I find fewer battles to prescribe unneccessary antibiotics. Patients, in general, will not fight a diagnosis of a viral infection, with no need for an antibiotic. When I utilize "delayed prescribing": writing a script and telling the patient that they can use it if a secondary bacterial infection develops: the vast majority never fill the script. They just feel empowered to monitor their symptoms and not feel a barrier to care. "Beer break" is offensive. What physician drinks during the process of providing care--an impaired one. Judy
> On 7/13/06 5:31 PM, in article > 1152837116.086958.261690@b28g2000cwb.googlegroups.com, "judy.n" [quoted text clipped - 43 lines] > feels better that causes the resistant bugs to flourish in your area, so > spreading the word locally can have a significant effect. Murray Grossan - 19 Jul 2006 04:06 GMT On 7/18/06 6:33 AM, in article 1153229615.785865.24450@75g2000cwc.googlegroups.com, "judy.n"
> As a primary care physician: I take offense at the comment that it > "takes 5 minutes to write for an antibiotic and have time for a beer [quoted text clipped - 68 lines] >> feels better that causes the resistant bugs to flourish in your area, so >> spreading the word locally can have a significant effect. Judy, I am sorry you misread what I wrote. Of course I didn't mean a beer break, I was only trying to explain one of the problems in overuse of antibiotics. I think all physicians to attuned to this, but the patients put undue pressure on the doctor to Rx the latest antibiotic. Yes a good physician prescribes what is best for the patient. I do feel sad when my best effort results in the patient asking to see a different doctor.
Murray Grossan - 15 Jul 2006 17:46 GMT On 7/13/06 7:13 AM, in article 1152800004.648111.108540@i42g2000cwa.googlegroups.com, "judy.n"
> I'll check out the article. One of the problems in practice is the > trend to try and avoid antibiotics. It's worthwhile, but can be taken [quoted text clipped - 33 lines] >> >> Susan Its not the antibiotics that gets me.Study after study deals with doses and scheduels. None deal with drainage, nutritional support, attention to cilia, etc. At Tower ENT we routinely see patients who had 3 antibiotics for sinusitis. Instead of a fourth antibiotic, simply restoring cilia function was what cleared most- including tea, chicken soup.
Alison Chaiken - 14 Jul 2006 04:01 GMT > http://www.medscape.com/viewarticle/537244_1 I get a "page cannot be found" error when I follow this URL.
I read _Fast Food Nation_ and was disappointed that it didn't mention more about the use of antibiotics in cattle feed. In fact, the topic is mentioned only once, in an Afterword section. Most of the book is about E. coli and listeria poisoning, obesity and other health problems, the horrors of the meat-packing industry and the resistance of European countries to fast food chains.
BTW, thank you Judy and Susan for your recent illuminating discussions. I've learned a lot by reading them.
 Signature Alison Chaiken "From:" address above is valid. (650) 236-2231 [daytime] http://www.wsrcc.com/alison/ Evolution whispers within us. It does not shout orders. -- L.A. Times editorial, 05/10/06, via gtb
travmmann - 14 Jul 2006 10:16 GMT I can't get in to see the article-wants a user name!
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Kindest personal regards, Ray The Travellin' Man.....Ray Armstrong your eyes and ears on the Tweed!! Let's Keep Music Liiiiiiiiiiiive!!!!!!!
> x-no-archive: yes > [quoted text clipped - 14 lines] > > Susan Susan - 14 Jul 2006 13:11 GMT > I can't get in to see the article-wants a user name! Medscape requires registration, which is free, and they don't spam you. Once you subscribe, you can request email updates on all the news in various specialties important to you.
Susan
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