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Rx for Sinus Patients: Wait
Antibiotics Don’t Relieve Most Infections, Says Study
(WP) - If you’re one of the 20 million Americans who get a sinus infection each year, experts agree: You’re being prescribed antibiotics too often. Now some are saying you shouldn’t get them at all.
Antibiotics should never be prescribed for otherwise healthy adults with sinusitis, an analysis of a collection of studies concludes in The Lancet. Belgian and Swiss researchers who reviewed data from nine clinical trials involving more than 2,500 people with sinus infections found that the vast majority who received antibiotics didn’t need them. That’s because while 80 percent of patients diagnosed with an acute sinus infection are prescribed antibiotics, only 5 to 10 percent of such infections are bacterial and respond to the drugs. But doctors often have a hard time distinguishing between viral and bacterial strains.
Over-prescription of antibiotics for a host of medical conditions has led to widespread antibiotic resistance — meaning doctors have fewer drugs effective against many bacterial infections.
But the Lancet study’s conclusions conflict with sinus infection guidelines published last fall by the American Academy of Otolaryngology — Head and Neck Surgery. Those guidelines recommend antibiotics (usually amoxicillin) if symptoms last more than 10 days. And some experts are calling the study’s advice too extreme.
“There’s no question that antibiotic resistance is a huge issue when it comes to treating sinusitis,” said Richard Rosenfeld, chairman of otolaryngology at Long Island College Hospital in New York and the head of the task force that issued the guidelines. “After all, about 20 percent of all antibiotics prescribed for adults are given to treat sinus infections, and at least some of that is unnecessary.”
But Rosenfeld and others said the Lancet analysis was not a sufficient basis for changing clinical practice because it was a meta-analysis, not a randomized trial comparing patients treated with and without antibiotics. What’s more, said Rosenfeld, the analysis did not include patients diagnosed on the basis of CT scans, nasal cultures or other sophisticated tests.
“That means that patients most likely to have a bacterial sinus infection would have been excluded from the study,” said Rosenfeld.
A 2007 study in the Archives of Otolaryngology — Head and Neck Surgery by researchers at the University of Nebraska Medical Center was also critical of what it called over-prescription of antibiotics for sinus infections.
Sinuses are hollow spaces behind the nose, cheeks, forehead and eyes that are lined with mucous membranes. These membranes can become infected when a virus in the nose travels to the sinuses. Nose secretions caused by allergies, colds, cigarette smoke and environmental irritants can also travel to the sinuses and become trapped, causing a bacterial infection. In either case, said Stanley Chia, a staff otolaryngologist at the Washington Hospital Center, symptoms may include low-grade fever, pain and pressure behind the nose, headaches and a runny nose, sometimes with a colored discharge.
An infection that lasts up to four weeks is defined as an acute infection; one that lasts more than 12 weeks is considered chronic.
According to a press release that accompanied the Academy guidelines, sinus infections are among the most common and costly ailments of U.S. adults. Rodney Taylor , an associate professor of otolaryngology at the University of Maryland Medical Center, says doctors often prescribe antibiotics under pressure from patients anxious to stop the pain that often accompanies infections. Plus, he said, prescribing the drugs often takes less time for rushed doctors than explaining to a patient why drugs won’t help.
Better treatment choices, according to the Academy, are cleansing with a saline solution or using a nonprescription decongestant. Many physicians also recommend nonprescription painkillers, as needed, to relieve headaches and fever.
An antibiotic prescription is warranted for sinusitis patients with chronic health problems such as heart disease or diabetes, which could be exacerbated by a bacterial infection, said Taylor. Antibiotics can also curtail rare spreads of the infection to the eyes and even to the brain, said Chia.
According to the Centers for Disease Control and Prevention, the number of bacteria resistant to antibiotics has increased in the past decade, and many major bacterial infections — including tuberculosis, some pneumonias and a growing number of hospital-acquired illnesses — are becoming resistant to common antibiotics, such as amoxicillin, and even last-resort ones such as methicillin and vancomycin.
But a patient with a pounding headache from sinusitis typically is more focused on relief than the state of world microbials, say experts. The challenge, particularly for primary care doctors who treat the bulk of sinus infections, is to figure out when an infection is bacterial and when not.
While otolaryngologists can rely on sophisticated tools such as endoscopes — lighted tubes that can see inside nasal passages and detect pus in sinuses, a sign that an antibiotic may be needed — primary care doctors usually rely on nose secretions and a patient’s report, said Taylor. And while yellow or green mucus was once regarded as a sure sign of bacterial infection, doctors now know that this is not necessarily the case, leaving generalists without a clear sign of when to prescribe drugs. ^ and when not.
The Academy guidelines suggest that doctors consider prescribing antibiotics (usually amoxicillin) if symptoms - including colored nasal discharge - persist beyond 10 days, or improve within a 10-day period and then worsen.
Well, can’t believe that doctors are acting like doctors should. How odd.
Jet’s Door Falls Off During Takeoff
GRAND JUNCTION, Colo. — Aviation officials said the main passenger door fell off a twin-jet business plane as it was taking off from Grand Junction Regional Airport, but no one was hurt.
Federal Aviation Administration spokesman Mike Fergus said the front left side door tumbled from the Bombardier Challenger CL-60 shortly before 4 p.m. on Monday, forcing the plane to make an emergency landing.
Fergus said the plane was “climbing” when the door fell out. It landed in a desert area west of the airport property, he said.
No one on the plane or on the ground was hurt. There were two pilots on board the aircraft but no passengers.
As emergency crews waited, the jet circled back to the airport and landed safely. It was flying from Grand Junction to Rifle.
Fergus said investigators will look into why the door detached from the jet. FAA investigators are expected at the airport Tuesday.
The plane’s registered owner is WFP Investments of Snowmass Village. No one answered the company’s phone after business hours Monday.
Airport officials said the plane was towed to Westar Aviation for inspection.
Florida Governor Endorses McCain
St. PETERSBURG, FLA. (AP) - Florida Gov. Charlie Crist endorsed a beaming Sen. John McCain on Saturday night, delivering a boost three days before the state’s pivotal primary.
Crist said he would campaign for McCain in the coming days. “I just feel in my heart he’s the right man for the job at the right time,” he told reporters afterward.
The winner of next week’s primary will capture all 57 delegates at stake, a large prize that will set the stage for a virtual nationwide primary on Feb. 5.
Crist’s endorsement was sought by all the GOP presidential rivals, including Romney, former New York Mayor Rudy Giuliani and former Arkansas Gov. Mike Huckabee.
McCain said the nod “means a lot in this race.”
“I’m honored and privileged,” McCain told reporters. “And I intend to work very closely with him on the issues. We’ve got to provide home insurance for every person who lives in the path of a hurricane. We are going to have to work together to save the Everglades and other great environmental treasures of this state.”
He quipped: “We will continue to compete for both baseball spring training and for tourism.”
McCain does not support a national catastrophic insurance fund for Florida and other hurricane-prone states, instead saying he could bring industry and government together to protect homeowners. Crist does support a national fund.
It’s unclear what effect the two endorsements will have on McCain’s candidacy.
At the very least, the nods of Florida’s two top Republican elected officials could serve to validate McCain’s candidacy with the GOP establishment and counteract the fears among some that he would not be a loyal Republican while in the Oval Office.
Former Florida Gov. Jeb Bush, in an e-mail to the Associated Press, said: “I respect the governor’s decision but Republican voters will determine who they want among very fine candidates. I look forward to working for our party’s nominee in the general election.”
Bush has not endorsed a candidate but many of his allies and aides have backed Romney.
Crist, a popular first-term governor, had suggested he would stay out of the multi-candidate GOP primary, and played coy about his preferences for a year. He met with all the serious contenders, and appeared with some at events.
McCain campaigned for Crist during his 2006 campaign for governor, endorsing him before the primary and appearing with him the day before the election, when Crist opted not to appear with President Bush at a Pensacola rally.
Giuliani also campaigned with Crist, and Romney delivered a $1 million check as chairman of the Republican Governors Association.
While Crist has met with other Republican candidates in his office, he took an extra step last spring by introducing McCain at a fundraiser held a few blocks from the Capitol. During a debate last fall, when Crist introduced the Republican candidates, he warmly embraced McCain while shaking the hands of his rivals.
Crist has been seen as a moderate Republican. He has championed efforts to curb climate change, and was praised by former President Clinton for his efforts to restore voting rights of felons who have completed their sentences.
He also pushed for a law that requires a paper trail in state elections, a measure that bans the electronic voting machines his predecessor, Gov. Jeb Bush, sought after the 2000 presidential election. That election ended in a hotly contested recount, which President Bush won by 537 votes.
Say it isn’t so. John McCain as president? OMG.
Ooooh that smell, can’t you smell that smell
Goodsprings, Ala. (AP) - Human waste from New York is creating a stink in rural north Alabama. A Texas company has opened a plant that treats sewer sludge from New York and turns it into fertilizer that is spread on Alabama farmland. It’s a great deal for farmers, who get the fertilizer for free, but some in northwest Limestone County say they can’t stomach the stench.
“When the wind is right, we can’t even breathe,” said Lori Muse of Goodsprings. “People out here are really upset about it. It smells 10 times worst than a pig barn.”
Bill Daws, a county commissioner, called the odor, “the worst smell that I’ve ever smelled.”
“But we checked everything out and it all appears to be legit,” he told The News Courier of Athens, which first reported the flap.
Synagro Technologies Inc. of Houston, Texas, has a contract to dispose of human wastes from New York. The company treats sludge from wastewater plants in New York and ships it to Alabama by rail car by the ton.
The sludge is treated again at a plant in Leighton before it is spread on fields for farmers who sign up for the program, said Rodney Jackson, who investigated the arrangement for the Limestone County Commission after complaints started coming in.
People don’t like the idea of New York poop being shipped to Alabama for disposal, he said, and they were worried about the possibility that the fertilizer contained e-coli bacteria.
“According to the EPA it is not a health hazard, it is just a nuisance because of the smell,” he said.
And what a smell it is, according to some. “I’ve described it as chicken litter and a little more,” said Jackson, an enforcement office with the county revenue department.
Synagro spokeswoman Lorrie Loder said as many as 40 farmers in the area have signed up to receive the shipments and another 15 are on a waiting list.
“It is a safe product and it does produce an odor like most good fertilizers do,” said Loder.
Farmer Gary Peek said the free fertilizer is saving him a lot of money and enriching pasture land.
“I want to be a good neighbor,” he said. “I’m not looking to harm anyone. I’m just trying to make a living.”
Let’s have Lorrie’s back yard filled with ‘good fertilizer’ and have her children go out and play for a while. Also, can we really trust the EPA to give us a straight answer? More on the EPA in days to come. Maybe Synagro could ship the waste to China disguised as toys with lead paint.
Lyrics in header from Lynard Skynard, Street Survivors, That Smell, 1977.
MorganLighter
