Podcasting with the Curbsiders – please listen!

I just had the great honor of being a repeat guest for the Curbsiders.  Published today, we discuss #54: Upper Respiratory Infections: Coughs, colds, gargling, and antibiotic underuse?! Regular readers can probably imagine my comments.  I mostly focused attention on defining when upper respiratory infections are not routine.  As I have written previously, while we do not want to prescribe unnecessary antibiotics, we also do not want to withhold necessary antibiotics.  My concern with most guidelines and algorithms is the lack of specificity in defining routine bronchitis, sinusitis or pharyngitis in the context of the questions and physical examination findings that make those presumptive labels incorrect. Our job as physicians is to recognize the long tail diagnoses.  Upper respiratory infections have well defined warning signs.  On the podcast I spend much time emphasizing those red flags. As I have written recently, I am a big fan of limiting unnecessary antibiotics, but I do understand the trade off between sensitivity and specificity.  We have to prescribe some unnecessary antibiotics or else we will put other patients at risk by withholding antibiotics. Our challenge is defining the trade off, the warning signs (red flags) and the appropriate antibiotics for each clinical situation.  We produce much more antibiotic resistance from empiric broad spectrum antibiotics for “sepsis” (in quotations because too often it is not sepsis) than we do with narrow...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs