Antibiotic Use in Acute Upper Respiratory Tract Infections

Upper respiratory tract infections are responsible for millions of physician visits in the United States annually. Although viruses cause most acute upper respiratory tract infections, studies show that many infections are unnecessarily treated with antibiotics. Because inappropriate antibiotic use results in adverse events, contributes to antibiotic resistance, and adds unnecessary costs, family physicians must take an evidence-based, judicious approach to the use of antibiotics in patients with upper respiratory tract infections. Antibiotics should not be used for the common cold, influenza, COVID-19, or laryngitis. Evidence supports antibiotic use in most cases of acute otitis media, group A beta-hemolytic streptococcal pharyngitis, and epiglottitis and in a limited percentage of acute rhinosinusitis cases. Several evidence-based strategies have been identified to improve the appropriateness of antibiotic prescribing for acute upper respiratory tract infections.Copyright © 2022 American Academy of Family Physicians.

Rates of New Peanut Allergy and Discontinuation Following Introduction in High-Risk Infants

Rationale: Current guidelines recommend peanut introduction to high-risk infants. However, compliance and rates of new peanut allergy (PA) require further study. Methods: Participants aged 4-11 months with no prior peanut exposure and (i) diagnosis of non-peanut food allergy, (ii) moderate-severe atopic dermatitis, or (iii) first degree relative with PA were enrolled. PA status was determined by skin testing and food challenge. Participants without PA were advised to consume 2 grams of peanut protein three times/week. Monthly questionnaires were administered, with follow-up visits at 18 and 30 months. Results: At baseline, 35/326 (11%) participants were peanut allergic. Of 291 without PA, 78 (27%) discontinued peanut at least temporarily 115 times during follow-up because of suspected participant reaction (40%), fear of reaction (3%), reaction or fear of reaction in a family member (21%), participant refusal (9%), peanut introduction was too much work (3%), or other reasons (23%), including the COVID-19 pandemic. Six of 291 participants (2.1%) who consumed peanut developed PA (2 consistent with FPIES). Among 291 participants without PA at baseline, none of the 17 participants with initial skin prick test of at least 4 mm and <10 mm developed PA. Conclusions: New PA after early introduction recommendations was rare, confirming the LEAP study findings. Transient discontinuation was common, mostly due to suspected participant reaction. High-risk children may require substantial support to keep peanut in their diet.