News in brief - March 15, 2004

Cold kits stifle pleas for antibiotics - Postal workers could become foot soldiers in the war against terrorism - Antibiotics unnecessary for minor childhood skin infections - Gestational diabetes rates increased 35% in a decade

Cold kits stifle pleas for antibiotics

Minnesota physicians may have found a way to satisfy patients who hate to take no for an answer where antibiotics are concerned, researchers announced Feb. 29 at the International Conference on Emerging Infectious Diseases.

Patients with upper respiratory illnesses or acute bronchitis were provided boxes filled with over-the-counter pain relievers, decongestants, cough syrup and lozenges, powdered chicken soup and a teabag when their physicians believed an antibiotic would be of no help.

Researchers who examined whether the kits were effective found that patients who visited clinics where the kits were distributed were significantly less likely to fill a prescription for antibiotics within three days of their visit.

"In addition to the study data, we have had a lot of anecdotal feedback from physicians that it was a great idea to have something to give patients when you know they don't need antibiotics," said Pamala Gahr, MPH, a Minnesota Health Dept. epidemiologist and a researcher on the study.

Physicians in six health plans distributed approximately 31,000 kits during the 2000-2001 winter season. The kits were part of the Minnesota Antibiotic Resistance Collaborative's public education campaign, "Get Smart: Know When Antibiotics Work," which was mounted in conjunction with the Centers for Disease Control and Prevention.

Postal workers could become foot soldiers in the war against terrorism

Mail carriers could be called upon to deliver antibiotics door to door in the event of a catastrophic incident in which their rapid deployment is necessary, according to a plan under development by the U.S. Postal Service, the Dept. of Health and Human Services and the Dept. of Homeland Security.

The plan would supplement the public health system and would augment, not replace, local plans, according to a Feb. 18 announcement.

The Postal Service was approached because of its extensive delivery reach and the trust its carriers have in the nation's neighborhoods, according to officials. Individual postal employee participation would be on a voluntary basis.

Additional discussion of the plan with state and local officials will be required to determine the feasibility of incorporating the postal delivery aspect with municipality emergency planning.

Antibiotics unnecessary for minor childhood skin infections

Draining and wound packing is sufficient to cure small boils in children, and antibiotics are not needed, according to a study published in the February Pediatric Infectious Disease Journal.

Researchers at the University of Texas Southwestern Medical Center in Dallas studied 69 children presenting with minor skin infections who tested positive for non-methicillin-resistant Staphylococcus aureus. Nearly all were given antibiotics, although subsequent testing later showed that the bacteria were resistant to the one prescribed. Most also had their wound drained, and two-thirds had their wound bandaged. About a third were later given an antibiotic believed to be effective against their infection.

No differences were observed in children in relation to the antibiotic given.

"We were surprised," said R. Doug Hardy, MD, senior author on the paper and assistant professor of internal medicine and pediatrics at UT Southwestern. "What we found is that if a physician adequately drains the abscess, it will most likely get better with or without effective antibiotics."

Gestational diabetes rates increased 35% in a decade

Diabetes during pregnancy went up 35% from 1991 to 2000, according to a study published in the March issue of Obstetrics and Gynecology.

Researchers at Kaiser Permanente in Oakland, Calif., analyzed medical records of more than 267,000 HMO patients. Women giving birth in 2000 tended to be older than those in 1991 and more likely to be from a minority group, but even after controlling for these factors, the rate increased from 5.1% to 7.4% in 1997, although it leveled off at 6.9% in 2000.

Authors of the paper suggested that the increasing weight of women giving birth may be the driving factor in this increase and expressed concern because gestational diabetes can lead to prematurity and other complications.