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1 April 2003 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians, an organization of more than 115,000 internal medicine physicians and medical students. Note: As of March 31, 2003, ACP-ASIM name will change to ACP. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656.

Internists Recommend Tight Control of Blood Pressure for Managing Diabetes

New guidelines from the American College of Physicians say tight control of blood pressure should be a priority in managing people with type 2 diabetes and high blood pressure. (See news release. A video news release is also available).

Overall Antibiotic Use Is Down Substantially in the U.S., but Broad-Spectrum Antibiotic Use Is Up, Possibly Breeding a New Crisis of Antibiotic Resistance

Research on outpatient visits from a large national medical survey for three two-year periods between 1991 and 1999 found that visits involving an antibiotic prescription decreased from 13 percent to 10 percent among adults and from 33 percent to 22 percent among children (Article, p. 525). Overall the total number of antibiotic prescriptions decreased from 230 million in 1991-1992 to 190 million in 1998-1999. Antibiotics were prescribed less frequently to treat non-bacterial respiratory tract infections, such as the common cold. But selection of powerful broad-spectrum antibiotics doubled in both adults and children during this period. Further, the researchers found that by 1998-1999 broad-spectrum agents were often used for acute bronchitis and unspecified upper respiratory tract infections, conditions for which antibiotics are almost always useless.

Less use of antibiotics is good news, says an editorial writer (Editorial, p. 605). The bad news is the changing pattern of antimicrobial selection during the 1990s from more targeted therapy with narrow-spectrum drugs to broader-spectrum drugs. In addition to the large disparity in costs of the two types of drugs, the shift has global public health consequences for both the developed and developing world, the writer says. "It affects our ability to treat infections of major international importance, such as HIV, tuberculosis and malaria, as well as common infections primary care physicians face daily, such as otitis media, sinusitis, and pneumonia." The writer says, "We must consider these (broad-spectrum) drugs as precious, limited resources," because for many drugs, once resistance is gone, "there may be no going back."

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