Intended for healthcare professionals

Rapid response to:

Primary Care

Reducing antibiotic use for acute bronchitis in primary care: blinded, randomised controlled trial of patient information leafletCommentary: More self reliance in patients and fewer antibiotics: still room for improvement

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7329.91 (Published 12 January 2002) Cite this as: BMJ 2002;324:91

Rapid Response:

Unavoidable the Bed-side "etiological" Diagnosis of infectious disorder.

Sirs,

in my opinion, it is very difficult to know the real nature of an
infectious disorder at the bed-side, exclusively by means of the academic,
orthodox, physical semeiotics. Therefore, I am filled with wonder at
reading (Macfarlane R. et al. BMJ 2002;324:91, 12 January) that there are
doctors who are “sharing the uncertainty of the value of antibiotics for
acute bronchitis in the form of written and verbal advice “, although I
do not know if these physicians are skill at performing Biophysical
Semeiotics (http://digilander.iol.it/semeioticabiofisica).

Infact, only by
this original physical semeiotics doctor is able to recognize “clinically”
in a few of seconds the real nature of an infectious disease. For space
reasons, I underscore here merely the “chronic” antibodies synthesis in
the spleen during flu, as well as the spleen “small” antibody production,
in case of Gram-negative bacteria (Esch.coli, HP, a.s.o.).

Moreover,
interestingly Biophysical Semeiotics allows doctor to observe at the bed-
side, of course, and in “quantitative”way, the so-called Reticulo-
Endothelial-System-Hperfunction Syndrome (RESH), which parallels with ESR
and Proteins Electrophoresis, but is “more” sensitive and specific than
both (See the above brief remarks). Certainly, most adults with acute
bronchitis who consult their general practitioner (as well as University
Professors...) will receive antibiotics, although in many cases
antibiotics do not modify the natural course of the disorder. In my mind,
the real problem is to recognize “clinically” both the nature of
infectious disorder and the actual defence of the patient, including
antibodies synthesis: first, the “ethiological” diagnose and, then, the
therapy. Nowadays, we can solve the problem, if we are determined to are
“open-minded” physicians. May I doubt it?

Sergio Stagnaro MD., Active Member NYAS.

Competing interests: No competing interests

12 January 2002
Sergio Stagnaro
Specialist in Blood, Gastrointestinal and Metabolic Diseases
16037 Riva Trigoso (Genoa) Italy