ACP, CDC offer advice on prescribing antibiotics for common illnesses

Antibiotics are overused for the common cold, bronchitis, sore throat, and sinus infections - illnesses that often resolve on their own

HD video soundbites of ACP's Board of Regents chairperson discussing appropriate antibiotic use are available to download at http://www.dssimon.com/MM/ACP-antibiotics/. The URL for the paper will be live when the embargo lifts.

Free content: http://www.annals.org/article.aspx?doi=10.7326/M15-1840

URL goes live when embargo lifts

In a paper published in Annals of Internal Medicine, the American College of Physicians (ACP) and the Centers for Disease Control and Prevention (CDC) issued advice for prescribing antibiotics for acute respiratory tract infections (ARTIs) in adults. More often than not, these illnesses resolve on their own and do not require a prescription for antibiotics.

ARTIs, including the common cold, uncomplicated bronchitis, sore throat, and sinus infection, are the most common reason for doctor's office visits. According to unpublished CDC data, an estimated 50 percent of antibiotic prescriptions may be unnecessary or inappropriate in the outpatient setting, which equates to over $3 billion in excess costs. Antibiotics also are responsible for the largest number of medication-related adverse events and the cause of about one in five visits to emergency departments for adverse drug reactions.

ACP and the CDC say that antibiotics should never be prescribed for the common cold, and should not be prescribed for bronchitis, sore throat, or sinus infections unless a more serious illness is suspected. When appropriate, physicians should explain that antibiotics are not needed and have many side effects. Patients should be educated about how to manage their symptoms and the expected time of recovery. Physicians should also explain the risks and benefits of symptomatic therapy.

The full paper explains when additional testing and/or antibiotics may be required. It also includes evidence-based strategies to help physicians promote appropriate antibiotic prescriptions.

Media Contact: For embargoed PDFs of the full paper and press release, please contact Cara Graeff. To interview someone from ACP, please contact Steve Majewski, SMajewski@mail.acponline.org or 215-351-2514

2. U.S. dietary guidelines developed in "evidence-free zone"

Abstract: http://www.annals.org/article.aspx?doi=10.7326/M16-0035

URL goes live when embargo lifts

According to a commentary published in Annals of Internal Medicine, the 2015 Dietary Guidelines for America were developed in an "evidence-free zone." Steven E. Nissen, MD, Chair of the Cardiovascular Medicine department at Cleveland Clinic, questions the strength of scientific evidence used to support current and past dietary guidelines. A detailed review of the 2015 Scientific Report from the Dietary Guidelines Committee confirms a disturbing reality - the nearly complete absence of high quality randomized controlled clinical trials studying meaningful clinical outcomes for dietary interventions. The new guidelines reverse decades-long advice on saturated fats and cholesterol, based on a large high-quality randomized controlled trial conducted in Spain, demonstrating that such trials are feasibly useful. The author suggests that dietary guidelines should be based on the same quality evidence that is demanded in other fields of medicine.

Note: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, Dr. Steven Nissen, please contact Andrea Pacetti at pancetta@ccf.org or 216-444-8168 or Tora Vinci at vinciv@ccf.org or 216-444-2412.

3. In trial, acupuncture no better than sham for reducing menopausal hot flashes

Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-1380

URLs go live when embargo lifts

Standardized Chinese medicine acupuncture offers no additional benefit over noninsertive sham acupuncture for menopausal hot flashes. The randomized trial is published in Annals of Internal Medicine.

Up to 75 percent of menopausal women experience hot flashes, a cause of considerable loss of quality of life and financial burden. Acupuncturists are the second most consulted therapists by menopausal women, yet the evidence on acupuncture's efficacy for treating hot flashes is conflicting.

Researchers in Australia randomly assigned women over the age of 40 who were in the late menopausal transition or were in postmenopause to either 10 treatments of standardized Chinese medicine needle acupuncture designed to treat kidney yin deficiency or noninsertive sham acupuncture. After eight weeks, patients in both groups reported an approximately 40 percent decrease in hot flashes that was sustained for six months. The researchers found no evidence of an advantage of acupuncture over sham acupuncture on quality of life, anxiety, or depression.

Note: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, Dr. Carolyn Ee, please contact the University of Melbourne newsroom at news@media.unimelb.edu.au or +61 3 8344 4123.

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Also to be newly published on January 19:

Laparoscopic Lavage for Perforated Diverticulitis With Purulent Peritonitis: A Randomized, Controlled Trial
Anders Thornell, MD; Eva Angenete, MD, PhD; Thue Bisgaard, MD, DMSc; David Bock, PhD; Jakob Burcharth, MD, PhD; Jane Heath, RN; Hans-Christian Pommergaard, MD, PhD; Jacob Rosenberg, MD, DMSc; Nikolaj Stilling, MD; Stefan Skullman, MD, PhD; and Eva Haglind, MD, PhD
Original Research
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-1210

Trials of Surgical Treatment of Acute Perforated Diverticulitis: Finding What They Look For
Tim W. Eglinton, MBChB, MMedSc; Frank A. Frizelle, MBChB, MMedSc; University of Otago, Christchurch; Christchurch, New Zealand
Editorial
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-2788