Clinician Knowledge and Beliefs after Statewide Program to Promote Appropriate Antimicrobial Drug Use

In 1999, Wisconsin initiated an educational campaign for primary care clinicians and the public to promote judicious antimicrobial drug use. We evaluated its impact on clinician knowledge and beliefs; Minnesota served as a control state. Results of pre- (1999) and post- (2002) campaign questionnaires indicated that Wisconsin clinicians perceived a significant decline in the proportion of patients requesting antimicrobial drugs (50% in 1999 to 30% in 2002; p<0.001) and in antimicrobial drug requests from parents for children (25% in 1999 to 20% in 2002; p = 0.004). Wisconsin clinicians were less influenced by nonpredictive clinical findings (purulent nasal discharge [p = 0.044], productive cough [p = 0.010]) in terms of antimicrobial drug prescribing. In 2002, clinicians from both states were less likely to recommend antimicrobial agent treatment for the adult case scenarios of viral respiratory illness. For the comparable pediatric case scenarios, only Wisconsin clinicians improved significantly from 1999 to 2002. Although clinicians in both states improved on several survey responses, greater overall improvement occurred in Wisconsin

NTHi induction of Cxcl2 and middle ear mucosal metaplasia in mice

OBJECTIVE: Chronic Otitis Media (COM) develops after sustained inflammation and is characterized by secretory middle ear epithelial metaplasia and effusion, most frequently mucoid. Non-typeable Haemophilus influenzae (NTHi), the most common acute OM pathogen, is known to activate inflammation and mucin expression in vitro and in animal models of OM. The goals of this study were to examine histopathological and expression profiling epithelial effects of NTHi challenge in murine middle ears. STUDY DESIGN: In vitro and in vivo murine model of OM. METHODS: Weekly transtympanic inoculation of Balb/c mice with 300 μg/ml of NTHi lysates vs saline was performed. Histopathologic analysis was carried out at 4 weeks. Expression microarray analysis was performed at 1 and 7 days. Microarray findings were validated in independent animal samples and in a cultured murine middle ear epithelial cell (mMEEC) line. RESULTS: Histopathologic analyses revealed middle ear mucosal thickening after NTHi exposure. Microarray analyses of inflammatory response genes that changed significantly demonstrated that the chemokine Cxcl2 had the largest fold-change with significantly increased expression at 1 and 7 days after NTHi injection compared to either saline or no-injection (p<0.01). Validation by realtime qPCR revealed similar significantly increased relative mRNA levels for Cxcl2. NTHi lysates were also found to significantly up-regulate the transcription of Cxcl2 in mMEEC in a time and dose dependent manner (p<0.05). CONCLUSIONS: Middle ear NTHi challenge in mice leads to chronic epithelial mucosal metaplasia and over-expression of inflammatory mediators, most notably Cxcl2. This finding is parallel to NTHi mediated pulmonary mucosal metaplasia where Cxcl2 has been identified as an important inflammatory mediator