For those medical practitioners that don’t usually read EP Monthly, there are always good articles from some of the top names in emergency medicine. Lately, there have been several articles published that are exceptionally good.
Rick Bukata has a thought-provoking article about management of simple abscesses. Definitely worth a read. The bottom line is that most abscesses resolve just fine after they are lanced (medical terminology = Incision and Drainage or “I +D”). A majority of abscesses – 50 to 66% are due to MRSA (methicillin resistant staph aureus – a “superbug”). The organisms causing the abscesses were resistant to the antibiotics prescribed in some if the studies Rick cited, but the cure rates were still quite high – and were similar to those patients taking no antibiotics at all. Kind of interesting to consider that by giving antibiotics to patients with abscesses, we aren’t helping the patients and we could be increasing the prevalence of the same organisms we’re trying to eradicate.
So why do doctors keep prescribing antibiotics to patients with abscesses? I’m going to venture a few guesses:
1. They don’t keep up with the literature. Old habits die hard.
2. Many patients expect them. If patients expect antibiotics and don’t get them, then they complain to administration or give us bad Press Ganey scores. This is one of those perverse situations in which outside influences can affect proper medical care.
3. If there is a bad outcome, attorneys and journalists will sensationalize the case and fault the doctor for not giving antibiotics. Call it defensive medicine. It is a lot easier to fault someone for doing nothing than to fault them for doing something – even if that something is of marginal benefit.
Speaking about antibiotic use, an article from a few months ago by David Neuman (who works with Graham Walker and others over at theNNT.com – an excellent resource for clinicians) explores whether antibiotics are useful in preventing infections after mammalian bites and in treating “bronchitis”. Some of the results will surprise you, some of them shouldn’t surprise you. One interesting factoid: Out of 100 patients prescribed antibiotics for “bronchitis,” none receive any benefit and about three of them are harmed by the antibiotics themselves. I’d say that every one of the patients receiving antibiotics is harmed. They pay a lot of money for medicine that doesn’t do a thing to help them.
News you can use about pediatric appendicitis from Ghazala Q. Sharieff, including scoring systems, ways to predict severity, and potential testing to use if ultrasound is equivocal.