384
THE INDIAN JOURNAL OF PEDIATRICS
1996; Vol. 63. No. 3
Publishers, 1989 : 291-292: 3. W i n t h r o b e . Clinical Haematology. 7th e d i t i o n . P h i l a d e l p h i a : Lea a n d Febiger. 1975 : 908-910. 4. Roberton NRC. Neonatal Jaundice. In : R M e a d o w ed. Recent Advances in Paediatrics No 8. E d i n b u r g h : Churchill Livingstone, 1986 : 157-184. 5. M o l l i s o n PL. Blood transfusion in Clinical Medicine. 6the.dition. L o n d o n : Oxford, 1979 : 265. 6. H a b e r m a n S, Krafft CJ, Luecke PE. ABO i s o i m m u n i z a t i o n : the use of the specific C o o m b s and heat elution tests in the
detection of hemolytic disease. Journal of Paediatrics 1960; 56 : 471. 7. Z u e l z e r W, Cohen F. ABO h a e m o l y t i c d i s e a s e and heterospecific p r e g n a n c y . Paediatric Clinics of North America 1957; 4 : 405-428. 8. O s b o r n LM, Lenarsky C, O a k e s RC et al P h o t o t h e r a p y in full-term infants w i t h haemolytic disease secondary to ABO incompatibility. Paediatrics 1984; 74 : 371-374. 9. C r a w f o r d H, C u t b u s h M, F a l c o n e r H et al. Formation of immune A iso-antibodies w i t h special reference to h e t e r o g e n e t i c stimuli. Lancet 1952; 2 : 219-223.
LIMIT ANTIBIOTIC PRESCRIPTIONS TO OTITIS MEDIA T h e problem of peniciUin resistant pneumococci is growing. How serious is the problem in India ? Physicians can easily assess the prevalence of PRP in children by obtaining specimens from purulent conjunctivitis, draining acute otitis media or the nasopharynx of child-care children. The days of "treat when in doubt" are over. Outpatient antibiotic use must be limited to documented bacterial infections, i.e., definite acute otitis media or culture-proven~antigendetected streptococcal pharyngitis. The diagnosis of sinusitis, or purulent URl-the "wastebasket excuses".for antibiotic prescriptions-needs stringent criteria. The classification for sinusitis should be : (1) cough and rhinorrhea for atleast seven to 10 days duration, or (2) mucopurulent rhinorrhea with moderate fever. Current opinion suggests that most children older than age 4 with nonrecurrent acute otitis media might easily be treated with five to seven days of therapy. Phoned-in antibiotics for undocumented bacterial infections should be eliminated, and antimicrobial prophylaxis for recurrent otitis media should be stringently curtailed. It has been observed that acute otitis media caused by PRP might be effectively treated with ceftriaxone for four to five days, or oral clindamycin for I0 to 20 days might be adequate. Because of increasing resistance to ceftriaxone, single-dose ceftriaxone for acute otitis should be reserved for select situations. Vancomycin therapy is not necessary for uncomplicated recalcitrant acute otitis media caused by PRP. Children older than 24 months in child-care with recurrent otitis media could be Vaccinated with the available polysaccharide pneumococcal vaccine. Finally, we must take the few extra minutes to carefully examine the ears and to explain to families why we cannot prescribe antibiotics for simple URIs. The impact of antibiotic resistance upon every community, and, in particular, their young children, is now imminent. Abstracted from: Stan Block, AAP News, February 1996; Vol. 12 : 2; p. 12
