Thursday, April 30, 2015

Antibiotic Prescriptions Across the USA

Are antibiotics prescribed uniformly across the USA?  

Here is a novel report published in Clinical Infectious Diseases that details antibiotic prescription trends in 2011.  The results are eyeopening.

Healthcare providers prescribed 262.5 million courses of antibiotics in 2011(842 prescriptions per 1000 persons).The most commonly prescribed individual antibiotic agent was azithromycin. Family practitioners prescribed the most antibiotic courses (24%). Dentists also accounted for 10% of all prescriptions. The prescribing rate was higher in the South census region (931 prescriptions per 1000 persons) than in the West (647 prescriptions per 1000 persons; P < .001).  

What does this mean?   

The prescription of antibiotics is not uniform across the country.  These data serve as a good initial benchmark for future comparisons. As it is a commonly held belief that antibiotics are often prescribed unnecessarily, particularly for viral upper respiratory infections, efforts are need to address both antibiotic prescribing patterns and patient expectations for antimicrobial treatment. Studies are urgently needed to better characterize prescribing patterns and to more effectively target regions where antimicrobial use is extensive.

With the rise in both multi-drug resistant infections and Clostridium difficile infections, the time for action is now, this is a public health urgency.

Saturday, April 25, 2015

Lazaretto! Rock and Roll and Infectious Diseases

It is not often that a rock and roll song has a title related to infectious diseases. I got to thinking about this as I spun Jack White's latest LP on my home office turntable. 

Below is the video for the Jack White song, Lazaretto, in reference to historical hospitals (Lazarettos) for the quarantine of infectious diseases, such as plague victims in Venice. 

For a scholarly read on quarantine and lazarettos, click here

Another ID minded song should be mentioned, Cat Scratch Fever, by Ted Nugent. Not my favorite musical artist but noteworthy anyway.


Tuesday, April 7, 2015

Telemedicine and Infectious Diseases

The Virtual doctor is in! 
Finally a scholarly article on telemedicine and infectious diseases.

This manuscript caught my eye as I was reviewing my medical journals, a review article on telemedicine and infectious diseases published in Clinical Infectious Diseases

I have been providing telemedicine care for over 10 years to HIV positive patients in the Virginia Department of Corrections. The article summarizes many of my personal observations over the years. For chronic medical conditions such as HIV, telemedicine is a successful mechanism of consultation. It provides specialty access, is expedient and can be easily coordinated. For complicated inpatient and outpatient consults that require a proper physical examination, telemedicine is limited. Of note, there are no publications definitively proving that telemedicine is cost effective.

Here is an article that featured VCU Telemedicine in Broadband Communities Magazine.

One last point, from an infection prevention standpoint, telemedicine must certainly have an advantage:  there is no provider-patient physical contact making cross-transmission most unlikely.