BMJ  2006;333:396 (19 August), doi:10.1136/bmj.333.7564.396

Letter

Antibiotics and acute purulent rhinitis

Review is symptomatic of medicine today

EDITOR—The systematic review by Arroll and Kenealy shows the state of medicine today.¹ Journals contain volumes on the mysticism of ethics, conditions affecting communities with underlying problems far greater than the scope of the article, and a knowledge base of big severe illnesses but little on the most basic medical conditions.

Credit: OSCAR BURRELL/SPL

 

None of the articles quoted in the review gives any indication that the nose was ever examined. Was there any history of obvious causes of acute purulent rhinitis? Who is taught to examine a nose today? The article does not mention the conditions far more common than bacterial infection that cause acute discoloured secretions. There is no mention of the fact that discoloured secretion does not indicate infection: even eosinophils cause discoloration. The mention of the Cochrane analysis of chronic purulent rhinitis almost implies that there is a similarity to acute purulent rhinitis. And no attempt was made to show whether some of the side effects, diarrhoea, rash, etc, were part of the illness rather than problems from antibiotics.

The review simply shows the poor state of clinical capability in assessing the most basic and common conditions.

Johannesburg 2052, South Africa friedmanr{at}surgeon.co.za

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Competing interests: None declared.

References

1. Arroll B, Kenealy T. Are antibiotics effective for acute purulent rhinitis? Systematic review and meta-analysis of placebo-controlled randomised trials. BMJ 2006;333: 279-81. (5 August.)[Abstract/Free Full Text]

Related Article

Are antibiotics effective for acute purulent rhinitis? Systematic review and meta-analysis of placebo controlled randomised trials

B Arroll and T Kenealy
BMJ 2006 333: 279. [Abstract] [Full Text] [PDF]

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