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This happens to all of us when we hear someone's name at a party; if we don't focus on the name and perhaps make a mental association to the name to enhance memory storage, we will forget that name within minutes.

Patients with depression often experience problems with memory and verbal fluency; when the depression is resolved, the memory and verbal fluency typically resolve as well.

Brief history of antibiotic development as medicines. 1928: Alexander Fleming discovered the first antibiotic, penicillin.

However, it took over a decade before penicillin was introduced as a treatment for bacterial infections.

1930s: The first commercially available antibacterial was Prontosil, a sulfonamide developed by the German biochemist Gerhard Domagk . 1945: Penicillin was introduced on a large scale as a treatment for bacterial infections. This was possible through the work of Florey and Chain who managed to efficiently purify the antibiotic and scale-up production. The introduction of penicillin marked the beginning of the so-called “golden era” of antibiotics. Most of the antibiotic classes we use as medicines today were discovered and introduced to the market.

Each class typically contains several antibiotics that have been discovered over time or are modified versions of previous types.

There are for example numerous ?-lactams (pronounced beta-lactams) such as different penicillins and cephalosporins.

Today, there are very few novel antibiotics under development.

At the same time antibiotic resistant bacteria that survives antibiotic treatment are becoming more and more common, making available antibiotics ineffective.

Thus, we are inevitably facing a major health problem.

Read more about the problems with antibiotic discovery and development under


did we end up here?

People with sinus infections stay on antibiotics too long.

(Reuters Health) - Most people prescribed antibiotics for sinus infections are on treatment courses of 10 days or longer even though infectious disease doctors recommend five to seven days for uncomplicated cases, a U.S.

Researchers examined data from a sample representing an estimated 3.7 million adults treated for sinusitis and prescribed antibiotics in 2016. Overall, 70


of antibiotics prescribed were for 10 days or longer, the study found. “Any time antibiotics are used, they can cause


effects and lead to antibiotic resistance,” said senior study author Dr. Katherine Fleming-Dutra, deputy director of the Office of Antibiotic Stewardship at the U.S.

Centers for Disease Control and Prevention in Atlanta.

“This is why it is so important to only use antibiotics when they are needed and to use the right antibiotic for the minimum effective duration,” Fleming-Dutra said by email.

Common side effects of antibiotics can include rash, dizziness, nausea, diarrhea and yeast infections, she said. More serious side effects may include life-threatening allergic reactions and Clostridium difficile infection, which causes diarrhea that can lead to severe colon damage and death.

Antibiotic resistance occurs when bacteria develop the ability to defeat the drugs designed to kill them and can make infections harder to treat.

When antibiotics are prescribed for sinus infections, only five to seven days of therapy are needed for uncomplicated cases, when patients start to recover within a few days of starting treatment and if they don’t have signs that the infection has spread beyond the sinuses, according to the Infectious Diseases Society of America (IDSA).

These guidelines are relatively new, however, and it’s possible some of the longer courses of antibiotics prescribed in the study occurred because not all doctors have absorbed the new practice recommendations, Fleming-Dutra said.

Prior to 2012, the IDSA recommended 10 to 14 days of antibiotics for sinus infections in adults.

In the study, no penicillin or tetracycline prescriptions were for five-day courses and only 5 percent of prescriptions were for seven-day courses of penicillins, tetracyclines or fluoroquinolones.

When researchers excluded azithromycin, an antibiotic that’s not recommended for sinus


, they found that 91 percent of all antibiotic courses prescribed for sinus infections were for 10 days or longer. The study didn’t examine whether or how the duration of antibiotics prescriptions impacted treatment of sinus infections or the potential for side effects. Researchers also focused only on acute sinus infections, and by excluding some cases where the type of infection was unclear, they may have left out some acute cases, the study team notes in JAMA Internal Medicine. It’s also possible that in some cases, doctors prescribed antibiotics for 10 days or longer and instructed patients to stop after five to seven days unless they were still experiencing symptoms, said Dr.

Sharon Meropol, a researcher at Case Western Reserve University School of Medicine in Cleveland, Ohio, who wasn’t involved in the study.

One pitfall in this approach is that when patients improve slowly, it’s possible they’re infected with organisms that are resistant to the antibiotic they got prescribed, and they would recover faster if they switched to a different antibiotic instead of continuing the current one longer, Meropol said by email. acute bacterial sinusitis guidelines were written with the belief that if antibiotics were taken for shorter durations of time, that the bacteria would not be completely eradicated and that would risk persistent, recurrent and antibiotic resistant infections,” Meropol said. “But the recommendations have changed on this because subsequent studies have shown the opposite is true, that in fact if the patient is responding to treatment, five to seven days is safe and is usually enough,” Meropol added. “A longer treatment is not usually needed.” Amoxicillin recent research. Probiotics have been touted as a treatment for a huge range of conditions, from obesity to mental health problems. One of their popular uses is to replenish the gut microbiome after a course of antibiotics. The logic is – antibiotics wipe out your gut bacteria along with the harmful bacteria that might be causing your infection, so a probiotic can help to restore order to your intestines.

But while it might sound like sense, there is scant solid evidence suggesting probiotics actually work if taken this way. Researchers have found that taking probiotics after antibiotics in fact delays gut health recovery.

Part of the problem when trying to figure out whether or not probiotics work is because different people can mean a variety of things with the term ‘probiotic’. To a scientist, it might be seen as a living culture of microorganisms that typically live in the healthy human gut. But the powdery substance blister packs on supermarket shelves can bear little resemblance to that definition.

Even when researchers use viable, living bacterial strains in their research, the cocktail varies from one lab to another making it tricky to compare. “That’s the problem – there aren’t enough studies of any one particular probiotic to say this one works and this one doesn’t,” says Sydne Newberry of Rand Corporation, who carried out a large meta-analysis on the use of probiotics to treat antibiotic-induced diarrhoea in 2012.

You might also like: Newberry’s findings, reviewing 82 studies of nearly 12,000 patients, did find a positive effect of probiotics in helping to reduce the risk of antibiotic-induced diarrhoea. But due to the variation – and sometimes lack of clarity – on which bacterial strains had been used, there was no particular probiotic or cocktail of probiotics that could be pinpointed and recommended as working.

Since that 2012 study, the evidence in support of probiotic use after antibiotics hasn’t moved on a great deal. It's widely believed that antibiotics wipe out your gut bacteria – along with the harmful bacteria that might be causing your infection (Credit: Getty Images) Otitis Media: Diagnosis and Treatment.

This is a corrected version of the article that appeared in print.

University of Michigan Medical School, Ann Arbor, Michigan. Author disclosure: No relevant financial affiliations.

Abstract Etiology and Risk Factors Diagnosis Management of Acute Otitis Media Management of OME Tympanostomy Tube Placement Special Populations References.

Abstract Etiology and Risk Factors Diagnosis Management of Acute Otitis Media Management of OME Tympanostomy Tube Placement Special Populations References. Acute otitis media is diagnosed in patients with acute onset, presence of middle ear effusion, physical evidence of middle ear inflammation, and symptoms such as pain, irritability, or fever.

Acute otitis media is usually a complication of eustachian tube dysfunction that occurs during a viral upper respiratory tract infection. Streptococcus pneumoniae, Haemophilus influenzae , and Moraxella catarrhalis are the most common organisms isolated from middle ear fluid.

Management of acute otitis media should begin with adequate analgesia.

Antibiotic therapy can be deferred in children two years or older with mild symptoms. High-dose amoxicillin (80 to 90 mg per kg per day) is the antibiotic of choice for treating acute otitis media in patients who are not allergic to penicillin. Children with persistent symptoms despite 48 to 72 hours of antibiotic therapy should be reexamined, and a second-line agent, such as amoxicillin/clavulanate, should be used if appropriate. Otitis media with effusion is defined as middle ear effusion in the absence of acute symptoms. Antibiotics, decongestants, or nasal steroids do not hasten the clearance of middle ear fluid and are not recommended. Children with evidence of anatomic damage, hearing loss, or language delay should be referred to an otolaryngologist. Otitis media is among the most common issues faced by physicians caring for children.

Approximately 80% of children will have at least one episode of acute otitis media (AOM), and between 80% and 90% will have at least one episode of otitis media with effusion (OME) before school age.1 , 2 This review of diagnosis and treatment of otitis media is based, in part, on the University of Michigan Health System's clinical care guideline for otitis media.2.

An AOM diagnosis requires moderate to severe bulging of the tympanic membrane, new onset of otorrhea not caused by otitis externa, or mild bulging of the tympanic membrane associated with recent onset of ear pain (less than 48 hours) or erythema.

Middle ear effusion can be detected with the combined use of otoscopy, pneumatic otoscopy, and tympanometry. Adequate analgesia is recommended for all children with AOM.



therapy for lower-risk children with AOM should be considered. High-dose amoxicillin (80 to 90 mg per kg per day in two divided doses) is the first choice for initial antibiotic therapy in children with AOM.

Children with middle ear effusion and anatomic damage or evidence of hearing loss or language delay should be referred to an otolaryngologist. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to .

An AOM diagnosis requires moderate to severe bulging of the tympanic membrane, new onset of otorrhea not caused by otitis externa, or mild bulging of the tympanic membrane associated with recent onset of ear pain (less than 48 hours) or erythema.

Middle ear effusion can be detected with the combined use of otoscopy, pneumatic otoscopy, and tympanometry.

Adequate analgesia is recommended for all children with AOM. Deferring antibiotic therapy for lower-risk children with AOM should be considered.

High-dose amoxicillin (80 to 90 mg per kg per day in two divided doses) is the first choice for initial antibiotic therapy in children with AOM. Children with middle ear effusion and anatomic damage or evidence of hearing loss or language delay should be referred to an otolaryngologist.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.

For information about the SORT evidence rating system, go to .

Abstract Etiology and Risk Factors Diagnosis Management of Acute Otitis Media Management of OME Tympanostomy Tube Placement Special Populations References.

Usually, AOM is a complication of eustachian tube dysfunction that occurred during an acute viral upper respiratory tract infection.

Bacteria can be isolated from middle ear fluid cultures in 50% to 90% of cases of AOM and OME.

Streptococcus pneumoniae, Haemophilus influenzae (nontypable), and Moraxella catarrhalis are the most common organisms.3 , 4 H.

influenzae has become the most prevalent organism among children with severe or refractory AOM following the introduction of the pneumococcal conjugate vaccine.5 – 7 Risk factors for AOM are listed in Table 1 .8 , 9. Exposure to environmental smoke or other respiratory irritants.

Exposure to environmental smoke or other respiratory irritants.

Abstract Etiology and Risk Factors


Management of Acute Otitis Media Management of OME Tympanostomy Tube Placement Special Populations References. Previous diagnostic criteria for AOM were based on symptomatology without otoscopic findings of inflammation. The updated American Academy of Pediatrics guideline endorses more stringent otoscopic criteria for diagnosis.8 An AOM diagnosis requires moderate to severe bulging of the tympanic membrane ( Figure 1 ) , new onset of otorrhea not caused by otitis externa, or mild bulging of the tympanic membrane associated with recent onset of ear pain (less than 48 hours) or erythema. AOM should not be diagnosed in children who do not have objective evidence of middle ear effusion.8 An inaccurate diagnosis can lead to unnecessary treatment with antibiotics and contribute to the development of antibiotic resistance.

Erythema and bulging of the tympanic membrane with loss of normal landmarks are noted.

Erythema and bulging of the tympanic membrane with loss of normal landmarks are noted. OME is defined as middle ear effusion in the absence of acute symptoms.10 , 11 If OME is suspected and the presence of effusion on otoscopy is not evident by loss of landmarks, pneumatic otoscopy, tympanometry, or both should be used.11 Pneumatic otoscopy is a useful technique for the diagnosis of AOM and OME8 – 12 and is 70% to 90% sensitive and specific for determining the presence of middle ear effusion. By comparison, simple otoscopy is 60% to 70% accurate.10 , 11 Inflammation with bulging of the tympanic membrane on otoscopy is highly predictive of AOM.7 , 8 , 12 Pneumatic otoscopy is most helpful when cerumen is removed from the external auditory canal. Tympanometry and acoustic reflectometry are valuable adjuncts to otoscopy or pneumatic otoscopy.8 , 10 , 11 Tympanometry has a sensitivity and


of 70% to 90% for the detection of middle ear fluid, but is dependent on patient cooperation.13 Combined with normal otoscopy findings, a normal tympanometry result may be helpful to predict absence of middle ear effusion.

Acoustic reflectometry has lower sensitivity and specificity in detecting middle ear effusion and must be correlated with the clinical examination.14 Tympanocentesis is the preferred method for detecting the presence of middle ear effusion and documenting bacterial etiology,8 but is rarely performed in the primary care setting. Abstract Etiology and Risk Factors Diagnosis Management of Acute Otitis Media Management of OME Tympanostomy Tube Placement Special Populations References. Diagnosis established by physical examination findings and presence of symptoms.

Children six months or older with otorrhea or severe signs or symptoms (moderate or severe otalgia, otalgia for at least 48 hours, or temperature of 102.2°F [39°C] or higher): antibiotic therapy for 10 days.

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