Management of the patient with otitis externa.
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Biomedical subjects
Publications and source records attributed to K B Holten.
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Beta-lactam antibiotics include penicillins, cephalosporins and related compounds. As a group, these drugs are active against many gram-positive, gram-negative and anaerobic organisms. Information based on "expert opinion" and antimicrobial susceptibility testing supports certain antibiotic choices for the treatment of common infections, but less evidence-based literature is available to guide treatment decisions. Evidence in the literature supports the selection of amoxicillin as first-line antibiotic therapy for acute otitis media. Alternative drugs, such as amoxicillin-clavulanate, trimethoprim-sulfamethoxazole and cefuroxime axetil, can be used to treat resistant infections. Penicillin V remains the drug of choice for the treatment of pharyngitis caused by group A streptococci. Inexpensive narrow-spectrum drugs such as amoxicillin or trimethoprim-sulfamethoxazole are first-line therapy for sinusitis. Animal and human bites can be treated most effectively with amoxicillin-clavulanate. For most outpatient procedures, amoxicillin is the preferred agent for bacterial endocarditis prophylaxis. Beta-lactam antibiotics are usually not the first choice for empiric outpatient treatment of community-acquired pneumonia. Based on the literature, the role of beta-lactam antibiotics in the treatment of bronchitis, skin infections and urinary tract infections remains unclear.
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PURPOSE: To document the adult medicine experiences of family practice residents training in a small rural hospital. METHOD: The authors tracked all inpatient admissions and consults for the first year of a newly accredited family practice residency program, located in a small-town, 80-bed hospital. They analyzed the data for volume of admissions, sources of admissions, diagnoses, lengths of stay, and ICU experience. RESULTS: The residents saw a significant volume of patients, encountered a wide variety of diagnoses, and had ample opportunities for learning, in spite of the small number of occupied beds. CONCLUSION: Family practice residents in small hospitals can have sufficient inpatient training experiences in adult medicine. The authors believe that the Accreditation Council for Graduate Medical Education should encourage the development of residency programs in rural communities by simplifying the accreditation documentation requirements for smaller hospitals.