Letters

Effectiveness of antibiotic prophylaxis in critically ill patients

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7171.1526a (Published 28 November 1998) Cite this as: BMJ 1998;317:1526

Distinction must be made between tracheal inflammation and pneumonia

  1. P J Sanderson, Consultant microbiologist
  1. Edgware Community Hospital, Edgware, Middlesex HA8 0AD
  2. Intensive Care Unit, Hotel Dieu Hospital, F-69288 Lyons, France
  3. Princess Royal Hospital, Telford, Shropshire TF6 6TF
  4. Laboratory of Health Services Research and Italian Cochrane Centre, Mario Negri Institute, 20157 Milan, Italy
  5. Ospedale Maggiore, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
  6. Institute of Biostatistics, Medical School, University of Modena, Modena, and Italian Cochrane Centre, Mario Negri Institute, 20157 Milan, Italy

    EDITOR—It is ironic that D'Amico et al's meta-analysis of trials of antibiotic prophylaxis for respiratory infection1 appears in the same issue as the House of Lords' report on resistance to antibiotic drugs.2 D'Amico et al did not restrict diagnostic criteria and did not distinguish between tracheobronchitis and pneumonia in their analysis. Although this distinction can be difficult, it is worth recognising that colonisation of the trachea and tracheobronchitis are common but trivial events in intubated patients and are probably inevitable. Whether their prevention is worth while is doubtful.

    It would be interesting to know the comparative prevalence of tracheobronchitis in the 16% of treated and 36% of control patients who had “respiratory infection” in the trials that D'Amico et al studied. Inappropriate prophylaxis contributes to the overuse of antibiotics. We should remain cautious about topical and systemic prophylaxis for respiratory infection in critically ill patients and continue to try to separate true lung infection from tracheal inflammation.

    References

    Selective decontamination offers no advantage

    1. B Allaouchiche, Clinical fellow.,
    2. H Jaumain, Clinical fellow.,
    3. D Chassard, Associate professor
    1. Edgware Community Hospital, Edgware, Middlesex HA8 0AD
    2. Intensive Care Unit, Hotel Dieu Hospital, F-69288 Lyons, France
    3. Princess Royal Hospital, Telford, Shropshire TF6 6TF
    4. Laboratory of Health Services Research and Italian Cochrane Centre, Mario Negri Institute, 20157 Milan, Italy
    5. Ospedale Maggiore, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
    6. Institute of Biostatistics, Medical School, University of Modena, Modena, and Italian Cochrane Centre, Mario Negri Institute, 20157 Milan, Italy

      EDITOR—Our first comment on the study by D'Amico et al concerns the search through Medline.1 They have excluded a study by Godard et al, who conducted a double blind placebo controlled …

      View Full Text

      Sign in

      Log in through your institution

      Free trial

      Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
      Sign up for a free trial

      Subscribe