Volume 7

Infection control and antibiotic prescribing have been high on the list of priorities for clinicians working in acute medicine over recent years. Concerns about antibiotic resistance have encouraged many hospital-based and speciality society guidelines to take a broad spectrum approach to the septic patient. However, this approach risks exacerbating the problems of resistance and increasing the incidence of Clostridium Diffi cile diarrhoea, particularly amongst our elderly patients. Finding the appropriate balance is a key priority for physicians working at the hospital’s ‘front door’. Three of our review articles highlight some of the issues involved in this area. In an extensively researched review, Lille and Barlow provide a microbiological perspective on the topic of antibiotic resistance. Their approach suggests a mechanism for risk assessment in relation to the likelihood of antibiotic resistance, while the results of cultures are awaited. Although most hospitals have their own specifi c prescribing guidelines, the algorithms in this article should provide a useful reference guide. Two other reviews deal specifi cally with issues around management of acute respiratory illness. Distinction between community acquired pneumonia (CAP) and exacerbation of COPD remains a signifi cant area of confusion in relation to antibiotic prescribing. Inappropriate use of CAP severity scoring for patients with COPD frequently leads to over-use of intravenous antibiotics, for a condition which is often non-infective in origin.