Sinusitis, childbirth and URTIs

Too busy to catch up on the latest research? Let Dr Nicolette Price update you on recent papers.

Antibiotics and nasal steroid for acute sinusitis
JAMA 2007; 298: 2,487-96

Despite the clinical uncertainty of a bacterial cause for acute sinusitis in day-to-day practice, antibiotic prescribing rates for its treatment remain as high as 92 per cent in the UK.

There is strong likelihood of widespread over treatment, contributing to increasing antibiotic resistance and bearing obvious economic implications.

The authors assessed the effects of nasal steroids and of amoxicillin (alone or in combination) on symptom severity, duration and natural history of acute sinusitis. Neither was found to be effective, except in mild cases, where nasal steroid use was of some benefit.

Child bearing and levator injury
Aust N Z J Obstet Gynaecol 2007; 47: 491-5

There is an increasing trend towards delayed child bearing.

In Australia, over the past 30 years the average age at first child birth has increased from 23 to 28.

Pelvic floor disorders such as urinary incontinence and prolapse are commonly associated with levator ani trauma, which can be detected using various imaging techniques.

The authors investigated whether levator ani trauma sustained during delivery is associated with delay in first childbirth.

Around 800 women with urogynaecological symptoms were assessed.

Pubovisceral defects were commonly found to be associated with prolapse, but not with stress incontinence.

The authors remarked on the likelihood of a significant increase in the prevalence of prolapse in future years.

A prospective study is now under way in an attempt to detect obstetric risk factors for maternal birth trauma, such as augmentation of labour. Some factors might be amenable to change, unlike maternal age at first delivery.

Baclofen for maintenance of alcohol abstinence
Lancet 2007; 370: 1,915-22

The best treatment for patients with alcoholic cirrhosis remains maintenance of total alcohol abstinence.

The authors report this may lead to a substantial regression of fibrosis and, possibly, early cirrhosis.

However, achieving this can prove extremely elusive.

Anticraving drugs can be helpful; however there is concern that they may worsen liver disease.

This trial considered the use of baclofen in achieving and maintaining abstinence, because it is mainly excreted through the kidney unchanged.

The results appear very promising: 71 per cent of the patients allocated baclofen achieved and maintained abstinence compared with 29 per cent of the placebo group.

The drug appeared safe, was well tolerated and there were no hepatic side-effects.

Baclofen for binge eating
Int J Eat Disord 2007; 40: 687-91

Another interesting use for baclofen was investigated in this very small pilot study.

The authors tested the hypothesis that since there might be a relationship between the underlying mechanisms for binge eating disorders and substance misuse, that baclofen - which has been found to help with alcohol abstinence and with cocaine and opiate use disorders - might reduce the number of binge eating episodes.

The results of the study in seven women with binge-eating disorder were promising, and the researchers suggest that it is now appropriate for further studies to be carried out.

Public beliefs on antibiotics and URTIs
Br J Gen Pract 2007; 57: 942-7

Important factors influencing the decision to prescribe unnecessary antibiotics include diagnostic uncertainty, patients' expectations and physicians' assumptions regarding these expectations.

This Dutch study analysed public knowledge, beliefs and experiences of URTIs and antibiotic usage.

Although it found most people knew that antibiotics were effective for bacterial infections, just under half believed them of benefit for viral infections.

Those with a prolonged cough or a diagnosis of acute bronchitis had particularly high expectations.

The authors conclude that education of the public, particularly younger generations, is of great importance, along with avoiding unnecessary prescribing.

This is something usually far easier said than done.

Occupational violence towards GPs
Br J Gen Pract 2007; 57: 967-70

This questionnaire study assessed GPs' experiences of various forms of violence and aggression.

Results revealed that more women than men experienced sexual harassment, GPs who worked longer hours experienced more verbal abuse, and those who had experienced intimidation had worked in general practice for fewer years.

There was no significant difference in the number of urban and rural GPs who had experienced violence and aggression.

The authors suggest that improved training of GPs, in recognition of potentially violent situations and in how to diffuse them, is appropriate.

The quick study

Acute sinusitis is not effectively treated with either antibiotics and/or nasal steroids.

Childbirth at a later age increases the risk of intrapartum pelvic floor trauma.

Alcohol abstinence is more likely to be maintained in alcoholic cirrhosis patients given baclofen than placebo.

Eating disorders may also respond favourably to baclofen.

Antibiotics are still perceived by the public to be effective against viral infections.

Occupational violence in general practice is experienced by both urban and rural GPs and training to manage such situations is appropriate.

Dr Price is a medical examiner for the Department for Work and Pensions, a former GP in Hampshire and a member of our team who regularly reviews the journals.

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