Deeanna Franklin

BALTIMORE – There may be a link between romantic relationship anxiety and depression, and surprisingly, this association appears stronger in teenage boys than girls, Carl Weems, Ph.D., wrote in a poster presentation at a biennial meeting of the Society for Research on Adolescence in Baltimore.

Dr. Weems and coinvestigator Natalie Costa used two scales, the Experience in Close Relationships test and the Depression Symptom Checklist-90, to measure relationship anxiety and depression in 189 adolescents.

Participants were aged 13–19 years (mean age, 15 years), and 66% were female. Sixty-one percent were Hispanic, 27% were African American, and 12% were of other races.

The results showed that relationship anxiety was significantly associated with depression but was less strongly tied to depression in girls and more strongly linked to depression in boys.

Both genders had comparable relationship anxiety scores.

“A possible explanation is that it is more normative and accepted for girls to have relationship anxiety, whereas it is less normative and accepted for boys. When boys experience relationship anxiety, it may be more salient and more related to psychopathological symptoms,” Dr. Weems wrote.

Longitudinal research could establish whether relationship anxiety precedes depression, or vice versa.

BALTIMORE – There may be a link between romantic relationship anxiety and depression, and surprisingly, this association appears stronger in teenage boys than girls, Carl Weems, Ph.D., wrote in a poster presentation at a biennial meeting of the Society for Research on Adolescence in Baltimore.

Dr. Weems and coinvestigator Natalie Costa used two scales, the Experience in Close Relationships test and the Depression Symptom Checklist-90, to measure relationship anxiety and depression in 189 adolescents.

Participants were aged 13–19 years (mean age, 15 years), and 66% were female. Sixty-one percent were Hispanic, 27% were African American, and 12% were of other races.

The results showed that relationship anxiety was significantly associated with depression but was less strongly tied to depression in girls and more strongly linked to depression in boys.

Both genders had comparable relationship anxiety scores.

“A possible explanation is that it is more normative and accepted for girls to have relationship anxiety, whereas it is less normative and accepted for boys. When boys experience relationship anxiety, it may be more salient and more related to psychopathological symptoms,” Dr. Weems wrote.

Longitudinal research could establish whether relationship anxiety precedes depression, or vice versa.

BALTIMORE – There may be a link between romantic relationship anxiety and depression, and surprisingly, this association appears stronger in teenage boys than girls, Carl Weems, Ph.D., wrote in a poster presentation at a biennial meeting of the Society for Research on Adolescence in Baltimore.

Dr. Weems and coinvestigator Natalie Costa used two scales, the Experience in Close Relationships test and the Depression Symptom Checklist-90, to measure relationship anxiety and depression in 189 adolescents.

Participants were aged 13–19 years (mean age, 15 years), and 66% were female. Sixty-one percent were Hispanic, 27% were African American, and 12% were of other races.

The results showed that relationship anxiety was significantly associated with depression but was less strongly tied to depression in girls and more strongly linked to depression in boys.

Both genders had comparable relationship anxiety scores.

“A possible explanation is that it is more normative and accepted for girls to have relationship anxiety, whereas it is less normative and accepted for boys. When boys experience relationship anxiety, it may be more salient and more related to psychopathological symptoms,” Dr. Weems wrote.

Longitudinal research could establish whether relationship anxiety precedes depression, or vice versa.

BOSTON — There are several ways physicians can offer support to parents after a fetal death, Ruth C. Fretts, M.D., said at a meeting cosponsored by Harvard Medical School and Brigham and Women's Hospital.

She offered suggestions on counseling parents after a stillbirth, including use of a decision support worksheet and a kind of parental bill of rights. (See box.)

The worksheet takes a question-and-answer format and provides space for parents to list their own thoughts and questions. Although answers to the questions may vary by hospital, the questions address general concerns of grieving parents.

The worksheet was originally designed by a social worker in Chicago who had a stillbirth. “When a bad thing happens, all hell breaks loose. It's hard to even think. This is a checklist for the patient to hold, to look at, and to go through. … And it has a thoughtful approach to the value of an autopsy,” said Dr. Fretts, assistant professor of obstetrics and gynecology, Harvard Medical School, Boston.

Some questions on the worksheet:

▸ What are my options for burial or cremation?

▸ Should we see and/or hold our baby?

▸ Will pictures of my baby be taken?

▸ Will my baby have an autopsy or other tests?

▸ Can we have our baby blessed?

▸ Will my milk still come in after delivery?

▸ We have other children. Should we let them see the baby? What should we tell them?

In Australia, a perinatologist or fetal pathologist usually introduces himself or herself to the parents, expresses condolences, and explains that an autopsy may find out exactly why the baby died. The parents are told their baby will be returned to them and that great care will always be taken. The parents are more likely in this scenario to consent to an autopsy, she said.

The parental bill of rights was adapted from Share Pregnancy and Infant Loss Support Inc., a group that offers support to individuals who have lost a baby through stillbirth, miscarriage, or newborn death.

The term “bill of rights” is something of a misnomer. According to a statement from Cathi Lammert, R.N., the group's executive director, “The term 'rights' is not used as a mandate for the bereaved nor as a militant statement of demands. It is an affirmation for parents who wish to make decisions based on informed consent and to assume the parenting role in meaningful ways despite the tragic circumstances.”

Right of a Paren When a Baby Dies

The following is an abbreviated version of the rights listed in the Share guidelines, which should be tailored to fit state, local, and hospital polices:

▸ To be given the opportunity to see, hold, and touch their baby at any time before and/or after death, within reason.

▸ To have photographs of their baby taken and made available to the parents, or held in security until the parents want to see them.

▸ To be given as many mementos as possible.

▸ To name their child and bond with him or her.

▸ To observe cultural and religious practices.

▸ To be cared for by an empathetic staff who respects their feelings, thoughts, beliefs, and requests.

▸ To be with each other throughout hospitalization as much as possible.

▸ To be given time alone with their baby, allowing for individual needs.

▸ To be given information about the grieving process and support organizations.

▸ To have a discussion with the appropriate medical staff on options for an autopsy and other testing procedures.

▸ To plan a farewell ritual, burial, or cremation in compliance with local and state regulations and according to their personal beliefs, religion, or cultural tradition.

More information is available at

www.nationalshareoffice.com

BOSTON — There are several ways physicians can offer support to parents after a fetal death, Ruth C. Fretts, M.D., said at a meeting cosponsored by Harvard Medical School and Brigham and Women's Hospital.

She offered suggestions on counseling parents after a stillbirth, including use of a decision support worksheet and a kind of parental bill of rights. (See box.)

The worksheet takes a question-and-answer format and provides space for parents to list their own thoughts and questions. Although answers to the questions may vary by hospital, the questions address general concerns of grieving parents.

The worksheet was originally designed by a social worker in Chicago who had a stillbirth. “When a bad thing happens, all hell breaks loose. It's hard to even think. This is a checklist for the patient to hold, to look at, and to go through. … And it has a thoughtful approach to the value of an autopsy,” said Dr. Fretts, assistant professor of obstetrics and gynecology, Harvard Medical School, Boston.

Some questions on the worksheet:

▸ What are my options for burial or cremation?

▸ Should we see and/or hold our baby?

▸ Will pictures of my baby be taken?

▸ Will my baby have an autopsy or other tests?

▸ Can we have our baby blessed?

▸ Will my milk still come in after delivery?

▸ We have other children. Should we let them see the baby? What should we tell them?

In Australia, a perinatologist or fetal pathologist usually introduces himself or herself to the parents, expresses condolences, and explains that an autopsy may find out exactly why the baby died. The parents are told their baby will be returned to them and that great care will always be taken. The parents are more likely in this scenario to consent to an autopsy, she said.

The parental bill of rights was adapted from Share Pregnancy and Infant Loss Support Inc., a group that offers support to individuals who have lost a baby through stillbirth, miscarriage, or newborn death.

The term “bill of rights” is something of a misnomer. According to a statement from Cathi Lammert, R.N., the group's executive director, “The term 'rights' is not used as a mandate for the bereaved nor as a militant statement of demands. It is an affirmation for parents who wish to make decisions based on informed consent and to assume the parenting role in meaningful ways despite the tragic circumstances.”

Right of a Paren When a Baby Dies

The following is an abbreviated version of the rights listed in the Share guidelines, which should be tailored to fit state, local, and hospital polices:

▸ To be given the opportunity to see, hold, and touch their baby at any time before and/or after death, within reason.

▸ To have photographs of their baby taken and made available to the parents, or held in security until the parents want to see them.

▸ To be given as many mementos as possible.

▸ To name their child and bond with him or her.

▸ To observe cultural and religious practices.

▸ To be cared for by an empathetic staff who respects their feelings, thoughts, beliefs, and requests.

▸ To be with each other throughout hospitalization as much as possible.

▸ To be given time alone with their baby, allowing for individual needs.

▸ To be given information about the grieving process and support organizations.

▸ To have a discussion with the appropriate medical staff on options for an autopsy and other testing procedures.

▸ To plan a farewell ritual, burial, or cremation in compliance with local and state regulations and according to their personal beliefs, religion, or cultural tradition.

More information is available at

www.nationalshareoffice.com

BOSTON — There are several ways physicians can offer support to parents after a fetal death, Ruth C. Fretts, M.D., said at a meeting cosponsored by Harvard Medical School and Brigham and Women's Hospital.

She offered suggestions on counseling parents after a stillbirth, including use of a decision support worksheet and a kind of parental bill of rights. (See box.)

The worksheet takes a question-and-answer format and provides space for parents to list their own thoughts and questions. Although answers to the questions may vary by hospital, the questions address general concerns of grieving parents.

The worksheet was originally designed by a social worker in Chicago who had a stillbirth. “When a bad thing happens, all hell breaks loose. It's hard to even think. This is a checklist for the patient to hold, to look at, and to go through. … And it has a thoughtful approach to the value of an autopsy,” said Dr. Fretts, assistant professor of obstetrics and gynecology, Harvard Medical School, Boston.

Some questions on the worksheet:

▸ What are my options for burial or cremation?

▸ Should we see and/or hold our baby?

▸ Will pictures of my baby be taken?

▸ Will my baby have an autopsy or other tests?

▸ Can we have our baby blessed?

▸ Will my milk still come in after delivery?

▸ We have other children. Should we let them see the baby? What should we tell them?

In Australia, a perinatologist or fetal pathologist usually introduces himself or herself to the parents, expresses condolences, and explains that an autopsy may find out exactly why the baby died. The parents are told their baby will be returned to them and that great care will always be taken. The parents are more likely in this scenario to consent to an autopsy, she said.

The parental bill of rights was adapted from Share Pregnancy and Infant Loss Support Inc., a group that offers support to individuals who have lost a baby through stillbirth, miscarriage, or newborn death.

The term “bill of rights” is something of a misnomer. According to a statement from Cathi Lammert, R.N., the group's executive director, “The term 'rights' is not used as a mandate for the bereaved nor as a militant statement of demands. It is an affirmation for parents who wish to make decisions based on informed consent and to assume the parenting role in meaningful ways despite the tragic circumstances.”

Right of a Paren When a Baby Dies

The following is an abbreviated version of the rights listed in the Share guidelines, which should be tailored to fit state, local, and hospital polices:

▸ To be given the opportunity to see, hold, and touch their baby at any time before and/or after death, within reason.

▸ To have photographs of their baby taken and made available to the parents, or held in security until the parents want to see them.

▸ To be given as many mementos as possible.

▸ To name their child and bond with him or her.

▸ To observe cultural and religious practices.

▸ To be cared for by an empathetic staff who respects their feelings, thoughts, beliefs, and requests.

▸ To be with each other throughout hospitalization as much as possible.

▸ To be given time alone with their baby, allowing for individual needs.

▸ To be given information about the grieving process and support organizations.

▸ To have a discussion with the appropriate medical staff on options for an autopsy and other testing procedures.

▸ To plan a farewell ritual, burial, or cremation in compliance with local and state regulations and according to their personal beliefs, religion, or cultural tradition.

More information is available at

www.nationalshareoffice.com

WASHINGTON — Physicians understand that overuse of antibiotics is contributing to rising resistance rates, yet a large minority of physicians continue to prescribe antibiotics for viral illnesses, Mohmad G. Fakih, M.D., reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Dr. Fakih and his colleagues approached primary care physician members of Blue Cross Blue Shield of Michigan, and 277 physicians out of a total of 875 completed surveys. Among the respondents, 73 were pediatricians, 126 were family physicians, and 58 were internists. They were questioned on age; specialty; years and type of practice; geographic region; views regarding their education, medical knowledge, and management of upper respiratory infections (URIs); antibiotic use and resistance; and patient expectations.

Regarding their management of URIs, 74.6% of family physicians, 81.0% of internists, and 90.1% of pediatricians felt very secure in rating their knowledge at above average to excellent.

When queried about their treatment approach for URI with pharyngitis, with or without exudates and/or lymphadenopathy, internists were more likely than were family physicians and pediatricians to prescribe antibiotics when more symptoms were present.

Among doctors practicing for less than 10 years, 43% believed that managed care affected their choice of antibiotics, compared with 24% of physicians practicing more than 10 years who felt this way. Also, physicians practicing 10 years or less were more likely to believe patients were satisfied once they were given an antibiotic prescription (56.6% vs. 40.4%).

Antibiotic prescribing appeared to hinge on symptoms. Physicians offered antibiotics to more symptomatic patients, with 89.3% of them using diagnostic tests, such as a rapid antigen detection test or culture, said Dr. Fakih, a specialist in infectious diseases at St. John Hospital and Medical Center in Detroit.

“Physicians agreed that overuse of antibiotics is the major factor in increasing resistance; however, more than half of them would give an antibiotic when the diagnosis is not certain,” the researchers said.

A big surprise in the study was that 55% of those surveyed thought that penicillin resistance to group A streptococci was emerging. “There has never been any evidence of resistance to penicillin,” Dr. Fakih said in an interview with this newspaper.

The conference was sponsored by the American Society for Microbiology.

WASHINGTON — Physicians understand that overuse of antibiotics is contributing to rising resistance rates, yet a large minority of physicians continue to prescribe antibiotics for viral illnesses, Mohmad G. Fakih, M.D., reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Dr. Fakih and his colleagues approached primary care physician members of Blue Cross Blue Shield of Michigan, and 277 physicians out of a total of 875 completed surveys. Among the respondents, 73 were pediatricians, 126 were family physicians, and 58 were internists. They were questioned on age; specialty; years and type of practice; geographic region; views regarding their education, medical knowledge, and management of upper respiratory infections (URIs); antibiotic use and resistance; and patient expectations.

Regarding their management of URIs, 74.6% of family physicians, 81.0% of internists, and 90.1% of pediatricians felt very secure in rating their knowledge at above average to excellent.

When queried about their treatment approach for URI with pharyngitis, with or without exudates and/or lymphadenopathy, internists were more likely than were family physicians and pediatricians to prescribe antibiotics when more symptoms were present.

Among doctors practicing for less than 10 years, 43% believed that managed care affected their choice of antibiotics, compared with 24% of physicians practicing more than 10 years who felt this way. Also, physicians practicing 10 years or less were more likely to believe patients were satisfied once they were given an antibiotic prescription (56.6% vs. 40.4%).

Antibiotic prescribing appeared to hinge on symptoms. Physicians offered antibiotics to more symptomatic patients, with 89.3% of them using diagnostic tests, such as a rapid antigen detection test or culture, said Dr. Fakih, a specialist in infectious diseases at St. John Hospital and Medical Center in Detroit.

“Physicians agreed that overuse of antibiotics is the major factor in increasing resistance; however, more than half of them would give an antibiotic when the diagnosis is not certain,” the researchers said.

A big surprise in the study was that 55% of those surveyed thought that penicillin resistance to group A streptococci was emerging. “There has never been any evidence of resistance to penicillin,” Dr. Fakih said in an interview with this newspaper.

The conference was sponsored by the American Society for Microbiology.

WASHINGTON — Physicians understand that overuse of antibiotics is contributing to rising resistance rates, yet a large minority of physicians continue to prescribe antibiotics for viral illnesses, Mohmad G. Fakih, M.D., reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Dr. Fakih and his colleagues approached primary care physician members of Blue Cross Blue Shield of Michigan, and 277 physicians out of a total of 875 completed surveys. Among the respondents, 73 were pediatricians, 126 were family physicians, and 58 were internists. They were questioned on age; specialty; years and type of practice; geographic region; views regarding their education, medical knowledge, and management of upper respiratory infections (URIs); antibiotic use and resistance; and patient expectations.

Regarding their management of URIs, 74.6% of family physicians, 81.0% of internists, and 90.1% of pediatricians felt very secure in rating their knowledge at above average to excellent.

When queried about their treatment approach for URI with pharyngitis, with or without exudates and/or lymphadenopathy, internists were more likely than were family physicians and pediatricians to prescribe antibiotics when more symptoms were present.

Among doctors practicing for less than 10 years, 43% believed that managed care affected their choice of antibiotics, compared with 24% of physicians practicing more than 10 years who felt this way. Also, physicians practicing 10 years or less were more likely to believe patients were satisfied once they were given an antibiotic prescription (56.6% vs. 40.4%).

Antibiotic prescribing appeared to hinge on symptoms. Physicians offered antibiotics to more symptomatic patients, with 89.3% of them using diagnostic tests, such as a rapid antigen detection test or culture, said Dr. Fakih, a specialist in infectious diseases at St. John Hospital and Medical Center in Detroit.

“Physicians agreed that overuse of antibiotics is the major factor in increasing resistance; however, more than half of them would give an antibiotic when the diagnosis is not certain,” the researchers said.

A big surprise in the study was that 55% of those surveyed thought that penicillin resistance to group A streptococci was emerging. “There has never been any evidence of resistance to penicillin,” Dr. Fakih said in an interview with this newspaper.

The conference was sponsored by the American Society for Microbiology.

BALTIMORE – Most internationally adopted children become well-adjusted adolescents, Femmie Juffer, Ph.D, said at a meeting sponsored by the Society for Research on Adolescence.

But internationally adopted teens do have more behavior problems than their nonadopted peers–predominantly externalizing problems, said Dr. Juffer of the center for child and family studies, Leiden (the Netherlands) University.

In a poster presentation, she reported the results of a study of 172 adolescents (81 boys and 91 girls) adopted at younger than 5 months from Sri Lanka, South Korea, and Colombia. Data from a comparison group of 2,068 adolescents, aged 12–18 years, were also used in this longitudinal study.

Study results showed that most children with behavioral problems at age 7 years still had those problems at age 14. The boys reported fewer internalizing, externalizing, and total problems, compared with reports from mothers and teachers.

BALTIMORE – Most internationally adopted children become well-adjusted adolescents, Femmie Juffer, Ph.D, said at a meeting sponsored by the Society for Research on Adolescence.

But internationally adopted teens do have more behavior problems than their nonadopted peers–predominantly externalizing problems, said Dr. Juffer of the center for child and family studies, Leiden (the Netherlands) University.

In a poster presentation, she reported the results of a study of 172 adolescents (81 boys and 91 girls) adopted at younger than 5 months from Sri Lanka, South Korea, and Colombia. Data from a comparison group of 2,068 adolescents, aged 12–18 years, were also used in this longitudinal study.

Study results showed that most children with behavioral problems at age 7 years still had those problems at age 14. The boys reported fewer internalizing, externalizing, and total problems, compared with reports from mothers and teachers.

BALTIMORE – Most internationally adopted children become well-adjusted adolescents, Femmie Juffer, Ph.D, said at a meeting sponsored by the Society for Research on Adolescence.

But internationally adopted teens do have more behavior problems than their nonadopted peers–predominantly externalizing problems, said Dr. Juffer of the center for child and family studies, Leiden (the Netherlands) University.

In a poster presentation, she reported the results of a study of 172 adolescents (81 boys and 91 girls) adopted at younger than 5 months from Sri Lanka, South Korea, and Colombia. Data from a comparison group of 2,068 adolescents, aged 12–18 years, were also used in this longitudinal study.

Study results showed that most children with behavioral problems at age 7 years still had those problems at age 14. The boys reported fewer internalizing, externalizing, and total problems, compared with reports from mothers and teachers.

WASHINGTON — Inconsistent and unclear guidelines may be contributing to overprescribing of fluoroquinolones to treat community-acquired pneumonia, Conan MacDougall, Pharm.D., and colleagues said in a poster presentation at the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Treatment of community-acquired pneumonia (CAP) is one of the primary indications for fluoroquinolones for both inpatients and outpatients, according to guidelines issued by the Infectious Diseases Society of America (IDSA).

“[Fluoroquinolone] resistance, while generally low, appears to be increasing in Streptococcus pneumoniae as well as among gram-negative organisms. Thus, overuse and inappropriate use may compromise the future efficacy of this class of antibiotics,” reported the research team led by Dr. MacDougall, who was formerly with the department of clinical pharmacy at the University of California, San Francisco, but now is an infectious diseases fellow at Virginia Commonwealth University, Richmond.

The researchers did a retrospective, observational database review of pharmacy claims from four managed care organizations in Colorado from March 2000 to March 2003. A total of 4,538 patients were studied; 35% were aged 18–44 years, 35% were aged 45–64 years, and 30% were aged 65 or older. More than half of the patients (54%) were women.

All of the patients had a primary diagnosis of CAP with no significant comorbidity.

Overall, 72% of the patients were treated by a family physician and 26% were treated by an internist. The remaining 2% were seen by other specialists.

Floroquinolone use in this population rose 62% from 2000 to 2002, while macrolide use dropped 25% in the same time period, Dr. MacDougall reported.

Internists tended to prescribe the drugs more often than did family physicians, and patients aged older than 65 years received fluoroquinolones more often than did younger patients.

Also, the use of fluoroquinolones increased across all age groups during the course of the study.

The rise in fluoroquinolone use among older patients may be appropriate since these patients are at higher risk of having drug-resistant S. pneumoniae.

But increased prescribing of fluoroquinolones for younger patients with no cormorbidities who have a low risk of treatment failure is cause for concern.

In 2001, CAP treatment guidelines were issued by the American Thoracic Society, the Centers for Disease Control and Prevention, and the Canadian Thoracic and Infectious Diseases Societies, in addition to IDSA.

All four groups recommended macrolides and doxycycline as first-line therapy for CAP, but they differed on the indications for fluoroquinolone use.

The CDC included beta-lactam antibiotics among first-line choices, while the IDSA included fluoroquinolones. Also, the CDC recommended use of fluoroquinolones or macrolides in addition to beta-lactams only for patients in intensive care, Dr. MacDougall noted.

The American Thoracic Society and the Canadian Thoracic and Infectious Diseases Societies recommend fluoroquinolones for all inpatients, with or without the addition of a beta-lactam. The Canadian group was the only one to recommend fluoroquinolones for nursing home patients.

In its 2003 update to “Guidelines for CAP in Adults,” the IDSA recommended using a fluoroquinolone alone as first-line therapy only for adult outpatients who have had recent antibiotic therapy, all adult inpatients, and nursing home residents. For previously healthy adult outpatients, the guidelines now recommend first trying a macrolide or doxycycline.

Marketing may be driving greater demand for fluoroquinolones. However, guidelines issued by professional societies “are inconsistent and may be causing confusion,” Dr. MacDougall said in an interview with this newspaper.

The researchers cautioned that overuse of fluoroquinolones might raise the risk of drug resistance in other organisms, such as Escherichia coli.

The conference was sponsored by the American Society for Microbiology.

WASHINGTON — Inconsistent and unclear guidelines may be contributing to overprescribing of fluoroquinolones to treat community-acquired pneumonia, Conan MacDougall, Pharm.D., and colleagues said in a poster presentation at the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Treatment of community-acquired pneumonia (CAP) is one of the primary indications for fluoroquinolones for both inpatients and outpatients, according to guidelines issued by the Infectious Diseases Society of America (IDSA).

“[Fluoroquinolone] resistance, while generally low, appears to be increasing in Streptococcus pneumoniae as well as among gram-negative organisms. Thus, overuse and inappropriate use may compromise the future efficacy of this class of antibiotics,” reported the research team led by Dr. MacDougall, who was formerly with the department of clinical pharmacy at the University of California, San Francisco, but now is an infectious diseases fellow at Virginia Commonwealth University, Richmond.

The researchers did a retrospective, observational database review of pharmacy claims from four managed care organizations in Colorado from March 2000 to March 2003. A total of 4,538 patients were studied; 35% were aged 18–44 years, 35% were aged 45–64 years, and 30% were aged 65 or older. More than half of the patients (54%) were women.

All of the patients had a primary diagnosis of CAP with no significant comorbidity.

Overall, 72% of the patients were treated by a family physician and 26% were treated by an internist. The remaining 2% were seen by other specialists.

Floroquinolone use in this population rose 62% from 2000 to 2002, while macrolide use dropped 25% in the same time period, Dr. MacDougall reported.

Internists tended to prescribe the drugs more often than did family physicians, and patients aged older than 65 years received fluoroquinolones more often than did younger patients.

Also, the use of fluoroquinolones increased across all age groups during the course of the study.

The rise in fluoroquinolone use among older patients may be appropriate since these patients are at higher risk of having drug-resistant S. pneumoniae.

But increased prescribing of fluoroquinolones for younger patients with no cormorbidities who have a low risk of treatment failure is cause for concern.

In 2001, CAP treatment guidelines were issued by the American Thoracic Society, the Centers for Disease Control and Prevention, and the Canadian Thoracic and Infectious Diseases Societies, in addition to IDSA.

All four groups recommended macrolides and doxycycline as first-line therapy for CAP, but they differed on the indications for fluoroquinolone use.

The CDC included beta-lactam antibiotics among first-line choices, while the IDSA included fluoroquinolones. Also, the CDC recommended use of fluoroquinolones or macrolides in addition to beta-lactams only for patients in intensive care, Dr. MacDougall noted.

The American Thoracic Society and the Canadian Thoracic and Infectious Diseases Societies recommend fluoroquinolones for all inpatients, with or without the addition of a beta-lactam. The Canadian group was the only one to recommend fluoroquinolones for nursing home patients.

In its 2003 update to “Guidelines for CAP in Adults,” the IDSA recommended using a fluoroquinolone alone as first-line therapy only for adult outpatients who have had recent antibiotic therapy, all adult inpatients, and nursing home residents. For previously healthy adult outpatients, the guidelines now recommend first trying a macrolide or doxycycline.

Marketing may be driving greater demand for fluoroquinolones. However, guidelines issued by professional societies “are inconsistent and may be causing confusion,” Dr. MacDougall said in an interview with this newspaper.

The researchers cautioned that overuse of fluoroquinolones might raise the risk of drug resistance in other organisms, such as Escherichia coli.

The conference was sponsored by the American Society for Microbiology.

WASHINGTON — Inconsistent and unclear guidelines may be contributing to overprescribing of fluoroquinolones to treat community-acquired pneumonia, Conan MacDougall, Pharm.D., and colleagues said in a poster presentation at the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Treatment of community-acquired pneumonia (CAP) is one of the primary indications for fluoroquinolones for both inpatients and outpatients, according to guidelines issued by the Infectious Diseases Society of America (IDSA).

“[Fluoroquinolone] resistance, while generally low, appears to be increasing in Streptococcus pneumoniae as well as among gram-negative organisms. Thus, overuse and inappropriate use may compromise the future efficacy of this class of antibiotics,” reported the research team led by Dr. MacDougall, who was formerly with the department of clinical pharmacy at the University of California, San Francisco, but now is an infectious diseases fellow at Virginia Commonwealth University, Richmond.

The researchers did a retrospective, observational database review of pharmacy claims from four managed care organizations in Colorado from March 2000 to March 2003. A total of 4,538 patients were studied; 35% were aged 18–44 years, 35% were aged 45–64 years, and 30% were aged 65 or older. More than half of the patients (54%) were women.

All of the patients had a primary diagnosis of CAP with no significant comorbidity.

Overall, 72% of the patients were treated by a family physician and 26% were treated by an internist. The remaining 2% were seen by other specialists.

Floroquinolone use in this population rose 62% from 2000 to 2002, while macrolide use dropped 25% in the same time period, Dr. MacDougall reported.

Internists tended to prescribe the drugs more often than did family physicians, and patients aged older than 65 years received fluoroquinolones more often than did younger patients.

Also, the use of fluoroquinolones increased across all age groups during the course of the study.

The rise in fluoroquinolone use among older patients may be appropriate since these patients are at higher risk of having drug-resistant S. pneumoniae.

But increased prescribing of fluoroquinolones for younger patients with no cormorbidities who have a low risk of treatment failure is cause for concern.

In 2001, CAP treatment guidelines were issued by the American Thoracic Society, the Centers for Disease Control and Prevention, and the Canadian Thoracic and Infectious Diseases Societies, in addition to IDSA.

All four groups recommended macrolides and doxycycline as first-line therapy for CAP, but they differed on the indications for fluoroquinolone use.

The CDC included beta-lactam antibiotics among first-line choices, while the IDSA included fluoroquinolones. Also, the CDC recommended use of fluoroquinolones or macrolides in addition to beta-lactams only for patients in intensive care, Dr. MacDougall noted.

The American Thoracic Society and the Canadian Thoracic and Infectious Diseases Societies recommend fluoroquinolones for all inpatients, with or without the addition of a beta-lactam. The Canadian group was the only one to recommend fluoroquinolones for nursing home patients.

In its 2003 update to “Guidelines for CAP in Adults,” the IDSA recommended using a fluoroquinolone alone as first-line therapy only for adult outpatients who have had recent antibiotic therapy, all adult inpatients, and nursing home residents. For previously healthy adult outpatients, the guidelines now recommend first trying a macrolide or doxycycline.

Marketing may be driving greater demand for fluoroquinolones. However, guidelines issued by professional societies “are inconsistent and may be causing confusion,” Dr. MacDougall said in an interview with this newspaper.

The researchers cautioned that overuse of fluoroquinolones might raise the risk of drug resistance in other organisms, such as Escherichia coli.

The conference was sponsored by the American Society for Microbiology.

WASHINGTON — Physicians understand that overuse of antibiotics is contributing to rising resistance rates, yet a large minority continue to prescribe antibiotics for viral illnesses, Mohmad G. Fakih, M.D., reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Dr. Fakih and his colleagues approached primary care physician members of Blue Cross Blue Shield of Michigan in four separate regions of the state, and 277 physicians out of a total of 875 completed surveys. Among the respondents, 73 were pediatricians, 126 were family physicians, and 58 were internists. They were questioned on age; specialty; years and type of practice; geographic region; views regarding their education, medical knowledge, and management of upper respiratory infections (URIs); antibiotic use and resistance; and patient expectations.

Regarding their management of URIs, 75% of family physicians, 81% of internists, and 90% of pediatricians felt very secure in rating their knowledge at above average to excellent.

When queried about their treatment approach for URI with pharyngitis, with or without exudates and/or lymphadenopathy, internists were more likely than were family physicians and pediatricians to prescribe antibiotics when more symptoms were present.

Among doctors practicing for less than 10 years, 43% believed that managed care affected their choice of antibiotics, compared with 24% of physicians practicing more than 10 years who felt this way. Also, physicians practicing 10 years or less were more likely to believe patients were satisfied once they were given an antibiotic prescription (57% vs. 41%).

Antibiotic prescribing appeared to hinge on symptoms. Physicians offered antibiotics to more symptomatic patients, with 89% of them using diagnostic tests, such as a rapid antigen detection test or culture, said Dr. Fakih, an infectious diseases specialist at St. John Hospital and Medical Center, Detroit.

“Physicians agreed that overuse of antibiotics is the major factor in increasing resistance; however, more than half of them would give an antibiotic when the diagnosis is not certain,” the researchers said.

A big surprise in the study was that 55% of those surveyed thought that penicillin resistance to group A streptococci was emerging. “There has never been any evidence of resistance to penicillin,” Dr. Fakih told this newspaper.

He could not explain the regional prescribing variances, but suggested that differences in education or in patient populations might be involved. There were significant differences in knowledge of URI depending on region, with more antibiotic prescribing for viral symptoms in more populous areas. But demanding patients aren't the only factor; “physicians need to be educated. We can't blame it on the patients,” he said.

WASHINGTON — Physicians understand that overuse of antibiotics is contributing to rising resistance rates, yet a large minority continue to prescribe antibiotics for viral illnesses, Mohmad G. Fakih, M.D., reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Dr. Fakih and his colleagues approached primary care physician members of Blue Cross Blue Shield of Michigan in four separate regions of the state, and 277 physicians out of a total of 875 completed surveys. Among the respondents, 73 were pediatricians, 126 were family physicians, and 58 were internists. They were questioned on age; specialty; years and type of practice; geographic region; views regarding their education, medical knowledge, and management of upper respiratory infections (URIs); antibiotic use and resistance; and patient expectations.

Regarding their management of URIs, 75% of family physicians, 81% of internists, and 90% of pediatricians felt very secure in rating their knowledge at above average to excellent.

When queried about their treatment approach for URI with pharyngitis, with or without exudates and/or lymphadenopathy, internists were more likely than were family physicians and pediatricians to prescribe antibiotics when more symptoms were present.

Among doctors practicing for less than 10 years, 43% believed that managed care affected their choice of antibiotics, compared with 24% of physicians practicing more than 10 years who felt this way. Also, physicians practicing 10 years or less were more likely to believe patients were satisfied once they were given an antibiotic prescription (57% vs. 41%).

Antibiotic prescribing appeared to hinge on symptoms. Physicians offered antibiotics to more symptomatic patients, with 89% of them using diagnostic tests, such as a rapid antigen detection test or culture, said Dr. Fakih, an infectious diseases specialist at St. John Hospital and Medical Center, Detroit.

“Physicians agreed that overuse of antibiotics is the major factor in increasing resistance; however, more than half of them would give an antibiotic when the diagnosis is not certain,” the researchers said.

A big surprise in the study was that 55% of those surveyed thought that penicillin resistance to group A streptococci was emerging. “There has never been any evidence of resistance to penicillin,” Dr. Fakih told this newspaper.

He could not explain the regional prescribing variances, but suggested that differences in education or in patient populations might be involved. There were significant differences in knowledge of URI depending on region, with more antibiotic prescribing for viral symptoms in more populous areas. But demanding patients aren't the only factor; “physicians need to be educated. We can't blame it on the patients,” he said.

WASHINGTON — Physicians understand that overuse of antibiotics is contributing to rising resistance rates, yet a large minority continue to prescribe antibiotics for viral illnesses, Mohmad G. Fakih, M.D., reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Dr. Fakih and his colleagues approached primary care physician members of Blue Cross Blue Shield of Michigan in four separate regions of the state, and 277 physicians out of a total of 875 completed surveys. Among the respondents, 73 were pediatricians, 126 were family physicians, and 58 were internists. They were questioned on age; specialty; years and type of practice; geographic region; views regarding their education, medical knowledge, and management of upper respiratory infections (URIs); antibiotic use and resistance; and patient expectations.

Regarding their management of URIs, 75% of family physicians, 81% of internists, and 90% of pediatricians felt very secure in rating their knowledge at above average to excellent.

When queried about their treatment approach for URI with pharyngitis, with or without exudates and/or lymphadenopathy, internists were more likely than were family physicians and pediatricians to prescribe antibiotics when more symptoms were present.

Among doctors practicing for less than 10 years, 43% believed that managed care affected their choice of antibiotics, compared with 24% of physicians practicing more than 10 years who felt this way. Also, physicians practicing 10 years or less were more likely to believe patients were satisfied once they were given an antibiotic prescription (57% vs. 41%).

Antibiotic prescribing appeared to hinge on symptoms. Physicians offered antibiotics to more symptomatic patients, with 89% of them using diagnostic tests, such as a rapid antigen detection test or culture, said Dr. Fakih, an infectious diseases specialist at St. John Hospital and Medical Center, Detroit.

“Physicians agreed that overuse of antibiotics is the major factor in increasing resistance; however, more than half of them would give an antibiotic when the diagnosis is not certain,” the researchers said.

A big surprise in the study was that 55% of those surveyed thought that penicillin resistance to group A streptococci was emerging. “There has never been any evidence of resistance to penicillin,” Dr. Fakih told this newspaper.

He could not explain the regional prescribing variances, but suggested that differences in education or in patient populations might be involved. There were significant differences in knowledge of URI depending on region, with more antibiotic prescribing for viral symptoms in more populous areas. But demanding patients aren't the only factor; “physicians need to be educated. We can't blame it on the patients,” he said.

The Food and Drug Administration has issued a new warning for atomoxetine HCl concerning the potential for severe liver injury. The drug, indicated for the treatment of attention-deficit hyperactivity disorder in adults and children, has been available since 2002.

Two cases of severe liver injury were reported in a teenager and an adult who had taken atomoxetine (Strattera) for several months. Both patients recovered normal liver function after discontinuing the medication.

The revised labeling will state that severe liver injury may progress to liver failure, which can result in death or the need for an organ transplant. It will point out that because of the possible underreporting of adverse events, the actual number of cases of liver injury is unknown, and atomoxetine should be discontinued in patents who have developed jaundice or have laboratory evidence of liver injury.

Eli Lilly & Co., manufacturer of the medication, will issue “Dear Healthcare Provider” letters to alert prescribers to this new warning. “Our thorough review of the clinical trial and real-world data indicate that the benefit-risk profile for Strattera is positive,” Douglas Kelsey, M.D., a pediatrician and clinical research physician with Eli Lilly, said in a written statement.

Patient package inserts will also carry information detailing the signs and symptoms of liver problems.

Reports of any adverse events associated with Strattera can be reported directly to Eli Lilly at 800-LillyRx, or to the FDA's MedWatch program at 800-332-1088. MedWatch forms can be downloaded at http://www.fda.gov/medwatch/safety/3500.pdf

The Food and Drug Administration has issued a new warning for atomoxetine HCl concerning the potential for severe liver injury. The drug, indicated for the treatment of attention-deficit hyperactivity disorder in adults and children, has been available since 2002.

Two cases of severe liver injury were reported in a teenager and an adult who had taken atomoxetine (Strattera) for several months. Both patients recovered normal liver function after discontinuing the medication.

The revised labeling will state that severe liver injury may progress to liver failure, which can result in death or the need for an organ transplant. It will point out that because of the possible underreporting of adverse events, the actual number of cases of liver injury is unknown, and atomoxetine should be discontinued in patents who have developed jaundice or have laboratory evidence of liver injury.

Eli Lilly & Co., manufacturer of the medication, will issue “Dear Healthcare Provider” letters to alert prescribers to this new warning. “Our thorough review of the clinical trial and real-world data indicate that the benefit-risk profile for Strattera is positive,” Douglas Kelsey, M.D., a pediatrician and clinical research physician with Eli Lilly, said in a written statement.

Patient package inserts will also carry information detailing the signs and symptoms of liver problems.

Reports of any adverse events associated with Strattera can be reported directly to Eli Lilly at 800-LillyRx, or to the FDA's MedWatch program at 800-332-1088. MedWatch forms can be downloaded at http://www.fda.gov/medwatch/safety/3500.pdf

The Food and Drug Administration has issued a new warning for atomoxetine HCl concerning the potential for severe liver injury. The drug, indicated for the treatment of attention-deficit hyperactivity disorder in adults and children, has been available since 2002.

Two cases of severe liver injury were reported in a teenager and an adult who had taken atomoxetine (Strattera) for several months. Both patients recovered normal liver function after discontinuing the medication.

The revised labeling will state that severe liver injury may progress to liver failure, which can result in death or the need for an organ transplant. It will point out that because of the possible underreporting of adverse events, the actual number of cases of liver injury is unknown, and atomoxetine should be discontinued in patents who have developed jaundice or have laboratory evidence of liver injury.

Eli Lilly & Co., manufacturer of the medication, will issue “Dear Healthcare Provider” letters to alert prescribers to this new warning. “Our thorough review of the clinical trial and real-world data indicate that the benefit-risk profile for Strattera is positive,” Douglas Kelsey, M.D., a pediatrician and clinical research physician with Eli Lilly, said in a written statement.

Patient package inserts will also carry information detailing the signs and symptoms of liver problems.

Reports of any adverse events associated with Strattera can be reported directly to Eli Lilly at 800-LillyRx, or to the FDA's MedWatch program at 800-332-1088. MedWatch forms can be downloaded at http://www.fda.gov/medwatch/safety/3500.pdf

WASHINGTON — Physicians understand that overuse of antibiotics is contributing to rising resistance rates, yet a large minority of physicians continue to prescribe antibiotics for viral illnesses, Mohmad G. Fakih, M.D., reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Dr. Fakih and his colleagues approached primary care physician members of Blue Cross Blue Shield of Michigan in four separate regions of the state, and 277 physicians out of a total of 875 completed surveys.

Among the respondents, 73 were pediatricians, 126 were family physicians, and 58 were internists.

They were questioned on age; specialty; years and type of practice; geographic region; views regarding their education, medical knowledge, and management of upper respiratory infections (URIs); antibiotic use and resistance; and patient expectations.

Regarding their management of URIs, 74.6% of family physicians, 81.0% of internists, and 90.1% of pediatricians felt very secure in rating their knowledge at above average to excellent.

When queried about their treatment approach for URI with pharyngitis, with or without exudates and/or lymphadenopathy, internists were more likely than were family physicians and pediatricians to prescribe antibiotics when more symptoms were present.

Among doctors practicing for less than 10 years, 43% believed that managed care affected their choice of antibiotics, compared with 24% of physicians practicing more than 10 years who felt this way.

Also, physicians practicing 10 years or less were more likely to believe patients were satisfied once they were given an antibiotic prescription (56.6% vs. 40.4%), Dr. Fakih reported.

Antibiotic prescribing appeared to hinge on symptoms. Physicians offered antibiotics to more symptomatic patients, with 89.3% of them using diagnostic tests, such as a rapid antigen detection test or culture, said Dr. Fakih, a specialist in infectious diseases at St. John Hospital and Medical Center in Detroit.

“Physicians agreed that overuse of antibiotics is the major factor in increasing resistance; however, more than half of them would give an antibiotic when the diagnosis is not certain,” the researchers said.

A big surprise in the study was that 55% of those surveyed thought that penicillin resistance to group A streptococci was emerging. “There has never been any evidence of resistance to penicillin,” Dr. Fakih said in an interview with this newspaper.

He could not explain the regional variances in prescribing, but suggested that differences in physician education or in patient populations might be involved; one region studied included the Detroit area, while the northern region is more rural.

There were significant differences in knowledge of URI depending on region, with more antibiotic prescribing for viral symptoms in more populous areas.

But demanding patients aren't the only factor; “physicians need to be educated. We can't blame it on the patients,” he said.

The conference was sponsored by the American Society for Microbiology.

WASHINGTON — Physicians understand that overuse of antibiotics is contributing to rising resistance rates, yet a large minority of physicians continue to prescribe antibiotics for viral illnesses, Mohmad G. Fakih, M.D., reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Dr. Fakih and his colleagues approached primary care physician members of Blue Cross Blue Shield of Michigan in four separate regions of the state, and 277 physicians out of a total of 875 completed surveys.

Among the respondents, 73 were pediatricians, 126 were family physicians, and 58 were internists.

They were questioned on age; specialty; years and type of practice; geographic region; views regarding their education, medical knowledge, and management of upper respiratory infections (URIs); antibiotic use and resistance; and patient expectations.

Regarding their management of URIs, 74.6% of family physicians, 81.0% of internists, and 90.1% of pediatricians felt very secure in rating their knowledge at above average to excellent.

When queried about their treatment approach for URI with pharyngitis, with or without exudates and/or lymphadenopathy, internists were more likely than were family physicians and pediatricians to prescribe antibiotics when more symptoms were present.

Among doctors practicing for less than 10 years, 43% believed that managed care affected their choice of antibiotics, compared with 24% of physicians practicing more than 10 years who felt this way.

Also, physicians practicing 10 years or less were more likely to believe patients were satisfied once they were given an antibiotic prescription (56.6% vs. 40.4%), Dr. Fakih reported.

Antibiotic prescribing appeared to hinge on symptoms. Physicians offered antibiotics to more symptomatic patients, with 89.3% of them using diagnostic tests, such as a rapid antigen detection test or culture, said Dr. Fakih, a specialist in infectious diseases at St. John Hospital and Medical Center in Detroit.

“Physicians agreed that overuse of antibiotics is the major factor in increasing resistance; however, more than half of them would give an antibiotic when the diagnosis is not certain,” the researchers said.

A big surprise in the study was that 55% of those surveyed thought that penicillin resistance to group A streptococci was emerging. “There has never been any evidence of resistance to penicillin,” Dr. Fakih said in an interview with this newspaper.

He could not explain the regional variances in prescribing, but suggested that differences in physician education or in patient populations might be involved; one region studied included the Detroit area, while the northern region is more rural.

There were significant differences in knowledge of URI depending on region, with more antibiotic prescribing for viral symptoms in more populous areas.

But demanding patients aren't the only factor; “physicians need to be educated. We can't blame it on the patients,” he said.

The conference was sponsored by the American Society for Microbiology.

WASHINGTON — Physicians understand that overuse of antibiotics is contributing to rising resistance rates, yet a large minority of physicians continue to prescribe antibiotics for viral illnesses, Mohmad G. Fakih, M.D., reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Dr. Fakih and his colleagues approached primary care physician members of Blue Cross Blue Shield of Michigan in four separate regions of the state, and 277 physicians out of a total of 875 completed surveys.

Among the respondents, 73 were pediatricians, 126 were family physicians, and 58 were internists.

They were questioned on age; specialty; years and type of practice; geographic region; views regarding their education, medical knowledge, and management of upper respiratory infections (URIs); antibiotic use and resistance; and patient expectations.

Regarding their management of URIs, 74.6% of family physicians, 81.0% of internists, and 90.1% of pediatricians felt very secure in rating their knowledge at above average to excellent.

When queried about their treatment approach for URI with pharyngitis, with or without exudates and/or lymphadenopathy, internists were more likely than were family physicians and pediatricians to prescribe antibiotics when more symptoms were present.

Among doctors practicing for less than 10 years, 43% believed that managed care affected their choice of antibiotics, compared with 24% of physicians practicing more than 10 years who felt this way.

Also, physicians practicing 10 years or less were more likely to believe patients were satisfied once they were given an antibiotic prescription (56.6% vs. 40.4%), Dr. Fakih reported.

Antibiotic prescribing appeared to hinge on symptoms. Physicians offered antibiotics to more symptomatic patients, with 89.3% of them using diagnostic tests, such as a rapid antigen detection test or culture, said Dr. Fakih, a specialist in infectious diseases at St. John Hospital and Medical Center in Detroit.

“Physicians agreed that overuse of antibiotics is the major factor in increasing resistance; however, more than half of them would give an antibiotic when the diagnosis is not certain,” the researchers said.

A big surprise in the study was that 55% of those surveyed thought that penicillin resistance to group A streptococci was emerging. “There has never been any evidence of resistance to penicillin,” Dr. Fakih said in an interview with this newspaper.

He could not explain the regional variances in prescribing, but suggested that differences in physician education or in patient populations might be involved; one region studied included the Detroit area, while the northern region is more rural.

There were significant differences in knowledge of URI depending on region, with more antibiotic prescribing for viral symptoms in more populous areas.

But demanding patients aren't the only factor; “physicians need to be educated. We can't blame it on the patients,” he said.

The conference was sponsored by the American Society for Microbiology.

WASHINGTON — Inconsistent and unclear guidelines may be contributing to overprescribing of fluoroquinolones to treat community-acquired pneumonia, said Conan MacDougall, Pharm.D., and colleagues in a poster presentation at the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Treatment of community-acquired pneumonia (CAP) is one of the primary indications for fluoroquinolones for both inpatients and outpatients, according to guidelines issued by the Infectious Diseases Society of America (IDSA).

“[Fluoroquinolone] resistance, while generally low, appears to be increasing in Streptococcus pneumoniae as well as among gram-negative organisms. Thus, overuse and inappropriate use may compromise the future efficacy of this class of antibiotics,” reported the research team led by Dr. MacDougall, formerly with the department of clinical pharmacy at the University of California, San Francisco, but now is an infectious diseases fellow at Virginia Commonwealth University, Richmond.

The researchers did a retrospective, observational database review of pharmacy claims from four managed care organizations in Colorado from March 2000 to March 2003. A total of 4,538 patients were studied; 35% were aged 18-44 years, 35% were aged 45-64 years, and 30% were aged 65 or older. More than half of the patients (54%) were women. All had a primary diagnosis of CAP with no significant comorbidity. Seventy-two percent of patients were treated by a family physician and 26% were treated by an internist. The remaining 2% were seen by other specialists.

Floroquinolone use in this population rose 62% from 2000 to 2002, while macrolide use dropped 25% in the same time period.

Internists tended to prescribe the drugs more often than did family physicians, and patients aged older than 65 years received fluoroquinolones more often than did younger patients.

The rise in fluoroquinolone use among older patients may be appropriate since these patients are at higher risk of having drug-resistant S. pneumoniae; however, increased prescribing of fluoroquinolones for younger patients with no cormorbidities who are a low risk of treatment failure is cause for concern.

In 2001, CAP treatment guidelines were issued by the American Thoracic Society, the Centers for Disease Control and Prevention, and the Canadian Thoracic and Infectious Diseases Societies, in addition to IDSA. All four groups recommended macrolides and doxycycline as first-line therapy for CAP, but differed on indications for fluoroquinolone use. The CDC included beta-lactam antibiotics among first-line choices, while the IDSA included fluoroquinolones.

The American Thoracic Society and the Canadian Thoracic and Infectious Diseases Societies recommend fluoroquinolones for all inpatients, with or without the addition of a beta-lactam.

In its 2003 update to “Guidelines for CAP in Adults,” the IDSA recommends using a fluoroquinolone alone as first-line therapy only for adult outpatients who have had recent antibiotic therapy, all adult inpatients, and nursing home residents. For previously healthy adult outpatients, the guidelines now recommend first trying a macrolide or doxycycline.

The conference was sponsored by the American Society for Microbiology.

WASHINGTON — Inconsistent and unclear guidelines may be contributing to overprescribing of fluoroquinolones to treat community-acquired pneumonia, said Conan MacDougall, Pharm.D., and colleagues in a poster presentation at the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Treatment of community-acquired pneumonia (CAP) is one of the primary indications for fluoroquinolones for both inpatients and outpatients, according to guidelines issued by the Infectious Diseases Society of America (IDSA).

“[Fluoroquinolone] resistance, while generally low, appears to be increasing in Streptococcus pneumoniae as well as among gram-negative organisms. Thus, overuse and inappropriate use may compromise the future efficacy of this class of antibiotics,” reported the research team led by Dr. MacDougall, formerly with the department of clinical pharmacy at the University of California, San Francisco, but now is an infectious diseases fellow at Virginia Commonwealth University, Richmond.

The researchers did a retrospective, observational database review of pharmacy claims from four managed care organizations in Colorado from March 2000 to March 2003. A total of 4,538 patients were studied; 35% were aged 18-44 years, 35% were aged 45-64 years, and 30% were aged 65 or older. More than half of the patients (54%) were women. All had a primary diagnosis of CAP with no significant comorbidity. Seventy-two percent of patients were treated by a family physician and 26% were treated by an internist. The remaining 2% were seen by other specialists.

Floroquinolone use in this population rose 62% from 2000 to 2002, while macrolide use dropped 25% in the same time period.

Internists tended to prescribe the drugs more often than did family physicians, and patients aged older than 65 years received fluoroquinolones more often than did younger patients.

The rise in fluoroquinolone use among older patients may be appropriate since these patients are at higher risk of having drug-resistant S. pneumoniae; however, increased prescribing of fluoroquinolones for younger patients with no cormorbidities who are a low risk of treatment failure is cause for concern.

In 2001, CAP treatment guidelines were issued by the American Thoracic Society, the Centers for Disease Control and Prevention, and the Canadian Thoracic and Infectious Diseases Societies, in addition to IDSA. All four groups recommended macrolides and doxycycline as first-line therapy for CAP, but differed on indications for fluoroquinolone use. The CDC included beta-lactam antibiotics among first-line choices, while the IDSA included fluoroquinolones.

The American Thoracic Society and the Canadian Thoracic and Infectious Diseases Societies recommend fluoroquinolones for all inpatients, with or without the addition of a beta-lactam.

In its 2003 update to “Guidelines for CAP in Adults,” the IDSA recommends using a fluoroquinolone alone as first-line therapy only for adult outpatients who have had recent antibiotic therapy, all adult inpatients, and nursing home residents. For previously healthy adult outpatients, the guidelines now recommend first trying a macrolide or doxycycline.

The conference was sponsored by the American Society for Microbiology.

WASHINGTON — Inconsistent and unclear guidelines may be contributing to overprescribing of fluoroquinolones to treat community-acquired pneumonia, said Conan MacDougall, Pharm.D., and colleagues in a poster presentation at the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Treatment of community-acquired pneumonia (CAP) is one of the primary indications for fluoroquinolones for both inpatients and outpatients, according to guidelines issued by the Infectious Diseases Society of America (IDSA).

“[Fluoroquinolone] resistance, while generally low, appears to be increasing in Streptococcus pneumoniae as well as among gram-negative organisms. Thus, overuse and inappropriate use may compromise the future efficacy of this class of antibiotics,” reported the research team led by Dr. MacDougall, formerly with the department of clinical pharmacy at the University of California, San Francisco, but now is an infectious diseases fellow at Virginia Commonwealth University, Richmond.

The researchers did a retrospective, observational database review of pharmacy claims from four managed care organizations in Colorado from March 2000 to March 2003. A total of 4,538 patients were studied; 35% were aged 18-44 years, 35% were aged 45-64 years, and 30% were aged 65 or older. More than half of the patients (54%) were women. All had a primary diagnosis of CAP with no significant comorbidity. Seventy-two percent of patients were treated by a family physician and 26% were treated by an internist. The remaining 2% were seen by other specialists.

Floroquinolone use in this population rose 62% from 2000 to 2002, while macrolide use dropped 25% in the same time period.

Internists tended to prescribe the drugs more often than did family physicians, and patients aged older than 65 years received fluoroquinolones more often than did younger patients.

The rise in fluoroquinolone use among older patients may be appropriate since these patients are at higher risk of having drug-resistant S. pneumoniae; however, increased prescribing of fluoroquinolones for younger patients with no cormorbidities who are a low risk of treatment failure is cause for concern.

In 2001, CAP treatment guidelines were issued by the American Thoracic Society, the Centers for Disease Control and Prevention, and the Canadian Thoracic and Infectious Diseases Societies, in addition to IDSA. All four groups recommended macrolides and doxycycline as first-line therapy for CAP, but differed on indications for fluoroquinolone use. The CDC included beta-lactam antibiotics among first-line choices, while the IDSA included fluoroquinolones.

The American Thoracic Society and the Canadian Thoracic and Infectious Diseases Societies recommend fluoroquinolones for all inpatients, with or without the addition of a beta-lactam.

In its 2003 update to “Guidelines for CAP in Adults,” the IDSA recommends using a fluoroquinolone alone as first-line therapy only for adult outpatients who have had recent antibiotic therapy, all adult inpatients, and nursing home residents. For previously healthy adult outpatients, the guidelines now recommend first trying a macrolide or doxycycline.

The conference was sponsored by the American Society for Microbiology.

BALTIMORE – Sleep disturbances are common in assisted-living facilities and may be linked to a variety of cognitive disorders, Patrick J. Raue, Ph.D., said in a poster session at the annual meeting of the American Association for Geriatric Psychiatry.

The researchers enrolled 198 assisted-living-facility residents who were chosen by randomly selecting room numbers from facilities that were randomly selected throughout Maryland. A specially designed 11-item questionnaire was used to identify symptoms of daytime sleepiness and insomnia. A consensus panel that included geriatric psychiatrists and nurses determined participant diagnoses.

Data showed that 66.5% of participants had dementia, and within this group 38% had no sleep disturbance and 62% had sleep disturbance of some kind, including insomnia (22%), excessive daytime sleepiness (23%), or both (17%), said Dr. Raue of the department of psychiatry at Cornell University, New York.

In participants with insomnia only, 45% had no dementia, 43% had Alzheimer's disease, 4% had vascular disease, and 9% had cognitive disorder not otherwise specified (NOS). In those with heightened symptoms of daytime sleepiness only, researchers found that 16% had no dementia, 44% had Alzheimer's disease, 34% had cognitive disorder NOS, and 6% had vascular disease. In participants who had both dementia and insomnia, 23% had Alzheimer's disease, 17% had vascular disease, 17% had cognitive disorder NOS, and 43% had none of these other ailments.

BALTIMORE – Sleep disturbances are common in assisted-living facilities and may be linked to a variety of cognitive disorders, Patrick J. Raue, Ph.D., said in a poster session at the annual meeting of the American Association for Geriatric Psychiatry.

The researchers enrolled 198 assisted-living-facility residents who were chosen by randomly selecting room numbers from facilities that were randomly selected throughout Maryland. A specially designed 11-item questionnaire was used to identify symptoms of daytime sleepiness and insomnia. A consensus panel that included geriatric psychiatrists and nurses determined participant diagnoses.

Data showed that 66.5% of participants had dementia, and within this group 38% had no sleep disturbance and 62% had sleep disturbance of some kind, including insomnia (22%), excessive daytime sleepiness (23%), or both (17%), said Dr. Raue of the department of psychiatry at Cornell University, New York.

In participants with insomnia only, 45% had no dementia, 43% had Alzheimer's disease, 4% had vascular disease, and 9% had cognitive disorder not otherwise specified (NOS). In those with heightened symptoms of daytime sleepiness only, researchers found that 16% had no dementia, 44% had Alzheimer's disease, 34% had cognitive disorder NOS, and 6% had vascular disease. In participants who had both dementia and insomnia, 23% had Alzheimer's disease, 17% had vascular disease, 17% had cognitive disorder NOS, and 43% had none of these other ailments.

BALTIMORE – Sleep disturbances are common in assisted-living facilities and may be linked to a variety of cognitive disorders, Patrick J. Raue, Ph.D., said in a poster session at the annual meeting of the American Association for Geriatric Psychiatry.

The researchers enrolled 198 assisted-living-facility residents who were chosen by randomly selecting room numbers from facilities that were randomly selected throughout Maryland. A specially designed 11-item questionnaire was used to identify symptoms of daytime sleepiness and insomnia. A consensus panel that included geriatric psychiatrists and nurses determined participant diagnoses.

Data showed that 66.5% of participants had dementia, and within this group 38% had no sleep disturbance and 62% had sleep disturbance of some kind, including insomnia (22%), excessive daytime sleepiness (23%), or both (17%), said Dr. Raue of the department of psychiatry at Cornell University, New York.

In participants with insomnia only, 45% had no dementia, 43% had Alzheimer's disease, 4% had vascular disease, and 9% had cognitive disorder not otherwise specified (NOS). In those with heightened symptoms of daytime sleepiness only, researchers found that 16% had no dementia, 44% had Alzheimer's disease, 34% had cognitive disorder NOS, and 6% had vascular disease. In participants who had both dementia and insomnia, 23% had Alzheimer's disease, 17% had vascular disease, 17% had cognitive disorder NOS, and 43% had none of these other ailments.