Changing antibiotic prescribing not a one-step process

Antibiotics should be used judiciously, but in clinical practice, this can be easier said than done. Physicians aiming to choose the right drug for the right condition must strive to combat not only patients' expectations for a prescription, but also their own. Because few diagnostic tests for infections are available, there may be a lingering fear that the cause is bacterial rather than viral and that the patient could be harmed if an antibiotic is not prescribed. Other common problems, according to experts, include not adjusting regimens properly and prescribing antibiotics for too long a time. Charlotte Huff discusses current efforts to better tailor antibiotic prescriptions and make the best use of these valuable and increasingly rare resources.

Stacey Butterfield takes a look at the state of hormone replacement therapy (HRT) 10 years after the Women's Health Initiative (WHI) trial was halted. While HRT use has, not surprisingly, decreased since the discovery of its possible link to adverse events, transdermal hormone therapies, nonhormonal therapies, and lower-dose HRT are drawing interest from physicians and patients. In addition, clinicians and researchers continue to debate the relevance of the WHI trial to younger women. As with many clinical controversies, a physician's best bet is to understand the risks and benefits, explain them clearly to patients, and help them make informed decisions based on their personal preferences.

In other clinical news, our story examines headaches, a common problem in primary care. Those severe enough to need medical treatment are often related to migraines, but they can also signal the presence of a more serious condition, and it takes time and skill to arrive at the correct diagnosis. Then the job of determining the appropriate treatment begins, and the internist must aim for the correct rung on the therapeutic ladder.

This month's Conference Coverage section brings you news from the American Diabetes Association's annual meeting, held earlier this year in Philadelphia. Experts at the meeting focused on diabetes self-management as an underused way to help control blood glucose levels via methods such as smartphones and targeted inpatient education.

Finally, our Letters to the Editor section features readers' reactions to a recent column on physician reimbursement. Let us know your thoughts on this and any other issues by e-mailing us. We always look forward to hearing from you.

Sincerely,

Jennifer Kearney-Strouse