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Medical Forum / Diseases and Disorders / Sinusitis / July 2006

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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
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> 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
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>
> 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
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>
> 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!

--

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
>
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>
> 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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