October 3rd, 2013
With all the talk of “superbugs” and antibiotic-resistant bacteria, you might think prescriptions for unnecessary antibiotics is relatively infrequent, especially for conditions where these drugs rarely work.
New research from Brigham and Women’s Hospital in Boston suggests the opposite. Dr. Michael L. Barnett, lead author, and Dr. Jeffrey A. Linder, senior author, found that prescriptions of antibiotics for sore throat and acute bronchitis are far more common than they should be.
“You have a viral infection for which the antibiotics are not going to help, and you’re putting a chemical in your body that has a very real chance of hurting you,” Linder said. Side effects of antibiotics include diarrhea, vaginitis in women, interactions with other medications and more serious reactions in a small number of people.
Also concerning: When you take antibiotics, there’s a chance the disease you’re fighting – or other bacteria in your body – will mutate, making it more resistant to antibiotics in the future.
“People may have infections that are harder to treat down the line because we’re overusing antibiotics today,” Linder said.
Disturbingly, says Linder, if you have taken an antibiotic recently there is a measurable amount of antibiotic-resistant bacteria on and inside you. It’s not possible to say any particular person is going to end up with an infection that’s resistant to antibiotics because of taking these drugs. But science has shown that community levels of antibiotic use are related to rates of antibiotic-resistant bacteria, Linder said.
Results from two studies by Linder and Barnett were presented at IDWeek 2013, a meeting of health professionals, this week.
In a research letter published in the journal JAMA Internal Medicine, the researchers showed that while only 10% of adults with sore throat have strep, the specific condition requiring antibiotics, doctors prescribe antibiotics in 60% of sore throat cases.
The study authors used data from large nationally representative surveys of ambulatory care in the United States: The National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. The surveys are sources of information on physicians and their practices.
Linder and Barnett analyzed data from 1997 to 2010 for more than 8,000 sore throat visits, from patients who did not have injuries, immunosuppression or other infectious diagnoses at the same time. Based on this information, they determined that physicians have been prescribing antibiotics in about 60% of sore throat visits since around 2000.
They also found that prescriptions for penicillin, the choice antibiotic for strep throat treatment, held steady at 9%, while the more expensive alternative azithromycin has been prescribed more and more. In 1997 to 1998, prescriptions for azithromycin for sore throat were too uncommon to reliably measure; in 2009 to 2010 it was prescribed in 15% of visits.
There are limitations to this study, however; the researchers have no way of knowing whether individual prescriptions for antibiotics are appropriate, and the surveys only include patients seen in clinic or emergency department settings.
“The financial cost of unnecessary antibiotic prescribing to adults with sore throat in the United States from 1997-2010 was conservatively $500 million,” the study noted. The cost could have actually been 40 times more expensive because of diarrhea and other side effects from antibiotics.
Researchers also found alarming trends regarding antibiotic overprescribing for acute bronchitis using nationally representative surveys. This study, unlike the research letter, has not been published in a peer-reviewed journal but was presented at IDWeek 2013.
Ideally, says Linder, antibiotics would almost never be prescribed for acute bronchitis because of the abundance of evidence that they do not actually help this condition.
Yet the prescribing rate of antibiotics for acute bronchitis nationally has remained steady over the past 30 years around 73%, he said.
Researchers excluded anyone who had a chronic lung disease such as asthma and emphysema from this study.
Why so many antibiotics?
Part of the problem of overprescribing is patient demand – people ask for antibiotics because they think these drugs will make them feel better. The other side of the coin is that many doctors have been prescribing antibiotics in abundance for years and are following old habits.
“I think there’s a discussion that should be happening between patient and doctor that doesn’t happen, that automatically leads to an antibiotic prescription,” Linder said.
If you have a sore throat, for instance, you can tell your doctor that you want to know if you have strep – and that if you don’t have it, you don’t need an antibiotic.
NY TIMES Health
OCTOBER 4, 2013By GRETCHEN REYNOLDS Question:
What’s the best way to relieve sore muscles?
I am a 56-year-old woman who exercises at least an hour a day. I am sore a lot of the time. What is the best approach to reducing muscle soreness? I know about foam rollers, protein, ice baths
Exercise could be described as Nietzschean. To make muscles fitter, you damage them slightly during workouts, prompting the fibers to repair themselves and become stronger. This process “is a good thing,” said Thomas Swensen, a professor of exercise and sports science at Ithaca College in New York. “You want to stress the muscles. They adapt positively.”
But in the meantime, they ache and, unfortunately, few methods reliably relieve the soreness. The painkiller ibuprofen, for instance, has little effect on exercise-related pain, studies show, and may actually reduce the ability of muscles to repair themselves. Similarly, post-exercise ice baths chill muscles, as you would expect, but do not, most studies show, make them less tender.
On the other hand, sports massage marginally reduces soreness, some studies suggest, although the overall effect is “too small to be clinically relevant,” a systematic review of massage-related studies concluded in 2012.
Ditto for arnica. A small study published in August in The European Journal of Sport Science found that runners who rubbed the substance onto their legs every four hours for three days after a punishing workout felt slightly less sore afterward than runners who did not.
Foam rollers, which you mention, may also be effective. In a small study published in July, young men who vigorously rolled their muscles like bread dough for 20 minutes after strength training were less sore later than a control group. (It is impossible, of course, to blind people as to whether they are receiving treatment in studies like this. You know if your muscles are being kneaded or not.)
But my favorite newly studied method of combating sore muscles is watermelon juice, which, according to an experiment published in July in The Journal of Agricultural and Food Chemistry, contains a hefty dose of l-citrulline, a substance that seems to protect muscles against pain. Cyclists who drank about 17 ounces of fresh watermelon juice an hour before completing a strenuous interval session experienced fewer aches afterward than riders drinking a placebo.
None of these methods, however, will eliminate post-exercise muscle soreness; at best, they can blunt it. But for most of us, the condition is self-limiting anyway, Dr. Swensen said, dissipating after a few days whether we treat it or not. If the achiness persists, especially after a normal exercise session (not one that is unusually strenuous or otherwise unfamiliar to your body), consult a doctor. Not all muscle aches are caused by exercise.
Chiropractic recognized as key contributor in treatment of back pain: The Foundation for Chiropractic Progress (F4CP) has endorsed the conclusion of a recent report, titled “Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: results of a pragmatic randomized comparative effectiveness study” (Spine; 4.15.2013).
The study found that for patients with low-back pain, the addition of chiropractic care to standard medical care (SMC) offered greater than a four-fold increase in patients whose pain and disability was “completely gone, much better, or moderately better.”
“The inclusion of chiropractic care in this study setting demonstrated that chiropractic can promote cost-effective and clinically efficient outcomes for musculoskeletal conditions,” shares Gerard Clum, DC, spokesperson, F4CP, who points of that the evidence-based care also ranks highly in terms of patient satisfaction. “Reports continue to confirm the extended value of chiropractic and support its inclusion within care delivery models, such as patient-centered healthcare homes (PCHCH) and accountable care organizations (ACOs).”
Source: Foundation for Chiropractic Progress