Jack Froom

Antimicrobials for acute otitis media? a review from the international primary care network

Increasing worldwide resistance of bacteria to antimicrobial drugs is causing a crisis, manifested by higher morbidity, mortality, and costs.1 In 1992 the Institute of Medicine in the United States warned of the growing threat posed by resistant bacteria,2 and in 1994 the Centers for Disease Control in Atlanta initiated a prevention strategy,3 linked to a global plan by the World Health Organisation.4 Proposed remedies include development of new antimicrobials, improved sanitation, and educating patients not to ask for antimicrobials when they are not useful and physicians to prescribe them conservatively.5nnAbout 30% of British children under the age of 3 visit their general practitioner for acute otitis media each year6 and 97% receive antimicrobials.7 In America it is the most common reason for outpatient antimicrobial use. Because this use has uncertain benefits, it merits reconsideration.nnIncreasing resistance to antimicrobial agents has been reported for the three most common bacterial causes of otitis media ( Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis ), but rates differ between countries.8 9 In England and Wales in 1990-5, resistance to penicillin by S pneumoniae increased from 1.5% to 3.9% and to erythromycin from 2.8% to 8.6%.10nnExcept in the Netherlands, antimicrobials are standard treatment for acute otitis media in most developed countries.7 11 Although type and duration vary between countries, generally ampicillin, amoxycillin, or co-amoxiclav (amoxycillin-clavulanate) are preferred, with co-trimoxazole a low cost alternative.7 In the Netherlands, treatment of symptoms without antimicrobials has been adopted as routine initial treatment for otitis media,12 and this policy is associated with decreased emergence of resistance among organisms commonly found in otitis media.13 14 This approach also is being adopted in Iceland.15nnSeven randomised blinded studies have compared antimicrobials with placebo in patients with acute otitis …

Opportunities, Challenges, and Lessons of International Research in Practice-Based Research Networks: The Case of an International Study of Acute Otitis Media

The requirements of research become more complex and demanding in international collaborations. The opportunity to study naturally occurring variation in treatment prompted networking primary care research networks in the United Kingdom, the Netherlands, and North America to study acute otitis media. Additional challenges faced and addressed in this study included (1) differing national requirements for protecting human subjects; (2) variation in data collection processes in primary care practices; (3) data transmission among participants; (4) duties and tariffs on necessary instruments; (5) fluctuation in currency exchange rates; (6) incapacitation of coinvestigators; (7) complex administration of funds; (8) financing the additional, legitimate costs of collaboration; (9) sustaining strong personal relationships among coinvestigators; and (10) accepting longer time frames than would otherwise be expected. Overall, international practice-based research can be productive, affect millions of people, and be extremely rewarding to investigators. It is not, however, for the faint-hearted.

Adoption of the sick role by prisoners: report on a multi-functional experiment.

Abstract The rights and obligations theoretically involved in the sick role are well known, and recently situational and institutional modifications in the theory have been suggested. In this research, we attempt to assess the extent to which prison inmates use the sick role for secondary gains rather than for acute illnesses. When the division of labor was restructured to include the option of lower levels of care for state prisoners, it was found that their desire for physicians care decreased dramatically. Although total sick role enactment remained constant when alternative sick call services were made available, most inmates chose to have only symbolic encounters in the health care system rather than consulting with physicians at the sick call.