propnate revisions of the present ic surgeons I was privileged to policy. work with, Dr. Fred Falls of Chicago and Dr. George Hooper of Eike-Henuer W. Kiluge, PhD Ottawa, were both in their middle Director of ethics and legal affairs 60s. Age is far less important than individual competence. Some individuals lose mental acuity and physical agility well before age 65. Abortion Others have a lot to contribute long after 65. and the DPG ratio I presume the debate is just I n his letter on this topic Dr. beginning. Brian A. Shamess (Can Med Strathn MD, FRCSC Assoc J 1991; 144: 277) states: Irvin 10 Robinhood Ct. "If the fetus is a human being Lincolnshire, Ill. (which indeed he or she is) . . ." This is the whole crux of the matter, because many people would say "which indeed it is not Susceptibility of as yet, though it may gradually Haemophilus influenzae become a human being in time." to antimicrobial agents To discuss this matter properly in used Canada one would also need to define what exactly a human being is and L ' ouise D. Tremblay and colif this is different from a fetus. leagues (Can Med Assoc J These questions will have to 1990; 143: 895-899, 901) be addressed soon, because the that the level of resistance suggest in increase the world's population is so rapid that within the next 25 of Haemophilus influenzae to anyears we are going to need contra- tibiotics has increased in Canada ception by any means, including and that the initial choice of drugs abortion, to avoid the destruction may have to be modified. This poses a difficulty in rural of our planet as a life support system and the consequent de- practice, where many times we struction of most of the human have to make judgement decisions race, whether we approve of the on initiating antibiotic use in a morality of these methods or not. patient that we suspect may have H. influenzae infection. Most of the laboratories in this region Michael LAttey, MD 215-1450 Chestnut St. have not observed increases in Vancouver, BC resistance and find that the wide range of antibiotics that have a fairly simple action are still very effective, especially in rural priMandatory retirement mary care settings (Dr. George Marion: personal communication, F ar-reaching" is an under- 1990). statement for mandatory I sometimes think that artiretirement at age 65 for cles such as this might lead rural physicians, as outlined in Judith physicians to use more powerful Bedford-Jones's article "Mandato- antibiotics than is warranted. It ry retirement ruling could have might be interesting to see if a far-reaching implications for doc- study could be done in which tors" (Can Med Assoc J 1991; rural primary care populations 144: 210-211). were compared with populations During my residency training in urban university settings. I days the two most able gynecolog- wonder if the data from urban 842

CAN MED ASSOC J 1991; 144 (7)

university settings such as are presented in this article are relevant to rural practice. Donald C. Paterson, MD PO Box 1000 Sorrento, BC

Tremblay and colleagues found that "the overall level of resistance was 19.3% to ampicillin" and conclude that "because these resistant strains cause different types of infection an antibiotic other than ampicillin should be given if H. influenzae infection is suspected." But if these results are true, do they apply to the patients in my family practice? I am concerned that this article may give a false impression to primary care physicians of a higher level of resistance to less expensive antibiotics than is actually the case. Most, if not all, of the centres in the study provide tertiary care. There is no mention of whether the 2644 isolates were from primary or tertiary care patients or a combination. If many were tertiary care patients the study would contain sampling bias, because patients in medical centres usually represent the serious end of the disease spectrum.' The susceptibility to antimicrobial agents can vary considerably depending on whether the population is from a primary care or referral-based setting. The authors express surprise that 22.2% of the strains isolated from the middle-ear fluid produced,-lactamase. However, the majority of patients with otitis media seen by primary care physicians do not require aspiration of middle-ear fluid. Do these patients harbour the same resistant strains as the patients in the authors' study? Tremblay and colleagues looked at various characteristics of the strains, but I think they overlooked a crucial one: the type of population from which the pa-

Susceptibility of Haemophilus influenzae to antimicrobial agents used in Canada.

propnate revisions of the present ic surgeons I was privileged to policy. work with, Dr. Fred Falls of Chicago and Dr. George Hooper of Eike-Henuer W...
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