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Update in Infectious Diseases
- John G. Bartlett, MD
- 1998-99 Series John Roberts, MD, Editor From Johns Hopkins University School of Medicine, Baltimore, Maryland. For the current author address, see end of text. Requests for Reprints: John G. Bartlett, MD, 1830 Monument Street, Room 437, Baltimore, MD 21205. Current Author Addresses: Dr. Bartlett: 1830 Monument Street, Room 437, Baltimore, MD 21205.
Updates in medicine are often out of date by the time they are presented, and this is especially true in infectious diseases. Even yesterday's advances are important, however, because today's progress is built on them.
Human immunodeficiency virus disease continues to evolve very rapidly, with guidelines that require updating several times a year. New infections continue to emerge both in the United States and around the world. Biological weapons must now be considered in discussions of emerging infections. And finally, resistance to antibiotics is spreading rapidly, and almost no community remains unaffected. As a consequence, physicians treating infectious diseases at the end of the 20th century may face clinical travails similar to those of physicians who treated infections at the century's beginning.
General Infectious Diseases
Numerous current issues in general infectious diseases are intimately related. For example, the increase in resistance to antibiotics is largely due to antibiotic overuse. Infections involving antibiotic-resistant pathogens are emerging, and international travel has made this a global problem.
Antibiotics Were Still Commonly Used for Self-Limited Infections
Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA. 1997; 278:901-4.
Previous studies showed that upper respiratory tract infections and acute bronchitis are the reason for as many as 30% of all antibiotic prescriptions. Such unnecessary use of antibiotics is believed to contribute heavily to the growing resistance of Streptococcus pneumoniae to penicillin. For example, the prevalence of carriage of resistant S. pneumoniae in day care centers has increased to 29% [1].
Gonzales and colleagues sought to measure prescribing rates and identify predictors of antibiotic use for adults who received diagnoses of colds, upper respiratory tract infections, and acute bronchitis. They identified 1529 practicing physicians who participated in the National Ambulatory Medical Care Survey in 1992, and they obtained information on diagnoses and prescriptions …
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