Intended for healthcare professionals

Rapid response to:

This Week In The Bmj

Antibiotics for acute purulent rhinitis-wait and watch

BMJ 2006; 333 doi: (Published 03 August 2006) Cite this as: BMJ 2006;333:0

Rapid Response:

What is the article setting out to prove

An excellent article on the state of medicine today. Journals today 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. Unfortunately a paucity of knowledge on the most basic medical conditions.

None of the articles quoted 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? No mention in the article of the conditions far more common than bactarial infection causing acute discoloured secretions. No mention of the fact that discoloured secretion does not indicate infection - even eosinphils cause discolouration. The mention of Cochrane analysis of chronic purulent rhinitis almost implying that there is any similarity to acute purulent rhinitis.

No attempt was made to show that some of the side effects, diarrhoea, rash etc were part of the illness rather than antibiotic problems.

I think the article showing the effect of phenylephrine basically exposes the above weaknesses well.

Unfortunately in my opinion, the article has little merit other than to show the poor state of clinical capability of assessing the most basic and common conditions

Competing interests:
None declared

Competing interests: No competing interests

04 August 2006
Raymond Friedman
ENT Specialist
Johannesburg South Africa, 2052