ObjectiveTo assess the potential overprescribing in patients with acute rhinosinusitis across six countries with different antibiotic prescribing rates and different prevalence of antibiotic resistance.Design, setting and subjectsA cross-sectional study including GPs from two Nordic countries, two Baltic countries and two Hispano-American countries registered patients with respiratory tract infections (RTIs) during three weeks in January 2008 as part of the EU-funded project “Health Alliance for Prudent Prescribing, Yield And Use of antimicrobial Drugs In the Treatment of respiratory tract infections” (HAPPY AUDIT).Main outcome measuresUse of antibiotics for acute rhinosinusitis based on the recommendations in the European Position Paper on Rhinosinusitis and Nasal Polyps 2007 (EP3OS).ResultsIn total, 618 participating GPs registered 33 273 patients with RTI of whom 1150 (3.46%) were considered to have acute rhinosinusitis. Over 50% of the patients with acute rhinosinusitis had symptoms for < 5 days and 81% were prescribed antibiotics. In total, 68% of the patients included were not prescribed antibiotics according to guidelines; 45% had symptoms < 5 days or no fever (possible overprescribing) and 23% had symptoms < 5 days and no fever (probable overprescribing).ConclusionA considerable number of patients with symptoms of acute rhinosinusitis were not managed according to European recommendations (EP3OS guidelines). To prevent overprescribing, efforts should be made to implement the recommendations in daily practice.
Background: In patients with lower respiratory tract infections (LRTIs) it is a challenge to identify who should be treated with antibiotics. According to international guidelines, antibiotics should be prescribed to patients with suspected pneumonia while acute bronchitis is considered a viral infection and should, generally, not be treated with antibiotics. Overdiagnosis of pneumonia in patients with LRTIs may lead to antibiotic overprescribing.
In studying mechanisms regulating the middle ear pressure it is essential to know the gas compositions of the middle ear. We have constructed a device which made it possible to sample middle ear gas without creating a negative pressure, thus eliminating the risk of admixture of atmospheric air. The samples were analysed by gas chromatography. In 26 normal subjects we found relatively stable values of carbon dioxide (median 52 mmHg, range 31-69 mmHg) and nitrogen (median 605 mmHg, range 563-627 mmHg). The values of oxygen were more fluctuating (median 54 mmHg, range 23-111 mmHg). In 10 of the subjects, arterial gases were determined simultaneously. No correlation could be shown between middle ear and arterial oxygen and carbon dioxide tensions. This investigation provides evidence contradicting the classical theory of a high negative middle ear pressure in Eustachian tube closure. We found strong indications that the Eustachian tube plays an active role in regulating the pressure in the normal middle ear, but variations in blood flow through the middle ear capillaries may also be an important regulating factor.
Methods for storage and analysis of gas samples were studied prior to measuring the composition of gas in the human middle ear cavity. Storage and analysis of gas samples are beset with several pitfalls. The dead space of the sampling syringe must be considered and the gas sample can equilibrate with the surrounding atmosphere, especially if the analysis cannot be done immediately. In this study the equilibration rate was found to fit an exponential function with a time constant of 0.004 min-1. The time constant was reduced by more than a factor of ten when butyl rubber stoppers were used to seal the syringes. Silicone rubber stoppers were less efficient. Disposable plastic syringes were found just as efficient as 'gas-tight' syringes.
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