|Bureau of Epidemiology|
|Bureau of Epidemiology||March 2000||Utah Department of Health|
Education of health care providers and patients about appropriate antibiotic use can help to curtail the problem of emerging antibiotic resistance. Researchers in rural Alaska provided education to community members and medical providers about the appropriate use of antimicrobials for children with upper respiratory infections.1 Two other areas served as non-intervention controls. Results showed a 22% decrease in antimicrobial prescriptions per respiratory visit in children under five years and a simultaneous 28% decline in pneumococcal isolates that were resistant to penicillin. No significant changes in either antibiotic usage or antibiotic resistance levels were seen in the non-intervention population.
The study in rural Alaska shows that education of health care providers and patients can lead to a change in how antibiotics are prescribed for upper respiratory illnesses. Similar educational efforts might be useful for other conditions. The administration of antibiotics for acute bronchitis has proven to be ineffective in most cases. Researchers have shown that the etiology of acute bronchitis is most often a virus such as adenovirus, coronavirus, influenza, parainfluenza, respiratory syncytial virus (RSV), or rhinovirus. Americans make more than 10 million office visits each year for bronchitis, and two-thirds receive antibiotics.2
Antibiotics are also excessively prescribed for patients presenting with pharyngitis. Nearly 70% of all patients with pharyngitis are given antibiotics, however, only 30-40% actually have a bacterial illness.2 According to the 1998 antibiotic use survey conducted in Utah by the Bureau of Epidemiology, primary care physicians in Utah prescribed antibiotics for pharyngitis between 25% and 75% of the time. Seventeen respondents (14%) specifically noted that they prescribed antibiotics only when a positive strep test or culture was available.
Nearly two-thirds of the 13 million patients diagnosed with sinusitis each year are also prescribed antibiotics. In the same 1998 survey conducted by the Bureau of Epidemiology, primary care physicians prescribed antibiotics for sinusitis between 25% and 75% of the time. However, studies have shown that no more than 10% of sinusitis patients have bacterial illness.1 Viruses cause the vast majority of acute sinus inflammation.
To avoid unnecessary treatment for sinusitis, only patients with sinusitis symptoms that persist for more than 10 days should be treated with antibiotics.2 Signs and symptoms of sinusitis may include the following: first, a history of purulent nasal discharge with unilateral predominance; second, a history of facial pain with unilateral predominance; and third, findings of purulent nasal discharge and pus in nasal cavity. When a patient presented with 0-1 of these signs and symptoms, less than 10% had bacteria in their sinuses based on direct sinus puncture. When more than two of these signs and symptoms were present, 67-85% of patients had bacterial sinusitis.3 Other predictors of bacterial versus viral sinusitis may include the following: colored nasal discharge, poor response to decongestants, maxillary toothache, and abnormal sinus transillumination.
The practice of treating the majority of cases of acute bronchitis, pharyngitis, and sinusitis, appears to be widespread despite its questionable clinical effectiveness. In addition, indiscriminate use of antibiotics is contributing to the problem of antibiotic resistance. Education of health care providers and patients has the proven potential to improve the situation. Strong educational efforts need to be undertaken and supported by public and private health care providers to help curb this problem.
As long as antimicrobial drugs are used, drug resistance will remain a challenge. The Centers for Disease Control and Prevention (CDC) vision is a world in which antimicrobial resistance is a manageable problem that does not compromise the availability of safe and effective drugs to treat infectious diseases. In collaboration with many private and public partners, the National Center for Infectious Diseases (NCID) plans the following public health activities to address the problem of antimicrobial resistance:
Surveillance and Response
Infrastructure and Training
Prevention and Control
Emerging Antimicrobial Drug Resistance
Dr. Gerberding outlines a 12 step program for controlling antimicrobial resistance in hospitals, including:
Eradicate Infection ASAP
Use Antimicrobials Wisely
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Utah Department of Health, Bureau of Epidemiology
Monthly Morbidity Summary
March 2000 - Provisional Data
The Epidemiology Newsletter is published monthly by the Utah Department of Health, Division of Epidemiology and Laboratory Services, Bureau of Epidemiology, to disseminate epidemiologic information to the health care professional and the general public.
Send comments to: The Bureau of Epidemiology, Box 142104, Salt Lake City, UT 84114-2104 or call (801) 538-6191
Approval 8000008: Appropriation 3705Rod Betit, Executive Director, Utah Department of Health
Charles Brokopp, Dr.P.H., Division of Epidemiology and Laboratory Services
Craig R Nichols, MPA, Editor, State Epidemiologist, Director Bureau of Epidemiology
Gerrie Dowdle, MSPH, Managing Editor
Connie Dean, Production Assistant