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When a physician tries to determine whether
or not a patient's cough or sore throat is caused by a bacterium
or a virus, they're correct only 50% of the time.
The findings show that a physicians' ability
to diagnose such ailments is "low and no more reliable
than tossing a coin.
The report suggests that it is not uncommon
for patients to receive antibiotics unnecessarily, or conversely,
that patients who might benefit from antibiotics don't get
them. Antibiotics can fight bacteria, but are useless in treating
infections caused by a virus.
In the study, the researchers looked at
250 adults over 21 years of age with a fever that had lasted
less than a week and either a cough, sore throat, hoarseness
or a head cold. A family doctor or emergency department physician
interviewed and examined patients before diagnosing the infection
as bacterial or viral. Blood was taken from patients at that
point, and again 3 to 4 weeks later.
The investigators tested the blood for
antibodies to a number of different bacteria and viruses.
Because antibodies to infectious agents can persist in the
body for years, the researchers diagnosed the illness based
on changes in antibody level between the first and second
blood test. Such a technique would be inappropriate for diagnosing
an illness before treatment.
The researchers found that doctors
correctly ruled out bacteria as a cause of infection only
60% of the time and correctly identified bacteria as the cause
of symptoms only 50% of the time.
British Journal
of General Practice 2001;51;998-1000
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