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April 02, 2002

Quinolone Resistance in Pneumococcal Pneumonia

In the March 7th issue of the New England Journal of Medicine, there is a warning sign: "Levofloxacin Resistance in Pneumococcal Pneumonia ."  This is coming sooner than most people can appreciate.  Gram positive resistance to quinolones will be here before we can say "-flox!" ...

Posted by Jacob Reider, MD at 11:45 PM |

Is This Patient Allergic to Penicillin?:

" Is This Patient Allergic to Penicillin?"

Posted by Jacob Reider, MD at 11:33 PM |

Antibiotics for acute bronchitis

Just a reminder:  "Overall, antibiotics appear to have a modest beneficial effect in patients who are diagnosed with acute bronchitis. The magnitude of this benefit, however, is similar to that of the detriment from potential adverse effects. Furthermore, patients with other symptoms of the common cold who have been ill for less than one week are not likely to have any benefit from antibiotics."

Posted by Jacob Reider, MD at 10:14 PM |

Otitis Media - practice changes: No Antibiotics Please

Like Chris Cates, I don't routinely use antibiotics to treat otitis media.  It's very clear that antibiotic use .. especially macrolides.. will lead to antimicrobial resistance.   When I do use antiobotics, I always use 1st-line agents.  Making the decision to use antiobotics remains a challenging one.  Gotta make the right doagnosis to start. 

A recent addition to our practice is an acoustic reflectomoeter.  The only brand that I've been able to find is the Ear-Check Pro. The device is simply wonderful!   There are a few papers from the mid-1990's on this topic.  The compelling feature is that the decise permits us to confirm normal ears quite well:  "[ears]were found to be highly predictive for normal ears as much as tympanometry." {ref}    So we can distinguish the red normal ear from the infected red ear without the struggles required for insufflation & observation of mobility.  The Acoustic reflectometer does not require that a seal be established, and takes only 1-2 seconds to provide a good reading.  No .. I don't own stock in the company ... and I doubt they're doing very well.  We bought ours last summer, and the AA batteries in the package had expired in 1998!

ref: Int J Pediatr Otorhinolaryngol 1999 May 5;48(2):137-42

Posted by Jacob Reider, MD at 01:16 AM |

Pediatrics: 4/2002

A few months ago, I was asked by a breastfeeding mother whether it was OK for her to breastfeed after exercise.  There was a study done in 1991 that raised some eyebrows about the lactic acid contant in post-exercise milk .. and another study that suggested that  the kids actually seemed to refuse to take the milk.  But there may have been some confounding factors (the milk was expressed and fed to the kids by bottle!) ... so this study was done to answer the question with some authority.   "Conclusion: These data support the hypothesis that moderate or even high-intensity exercise during lactation does not impede infant acceptance of breast milk consumed 1 hour postexercise. "

Posted by Jacob Reider, MD at 12:22 AM |