Global Differences in Approach to the Same Ailment

The New England Journal of Medicine periodically asks their online readers to give their opinions on a common condition, citing three possible responses and inviting comments and voting for what could be the best response. The most recent case involved an otherwise healthy 21-year old college basketball player who had a what amounted to a boil on his bum. NEJM presented three viewpoints for treatment: 1) Incision (or lancing) and draining the boil, 2) Incision and draining the boil plus a course of anti-MRSA (which stands for methicillin-resistant Staphylococcus aureus ... MRSA) drugs, or 3) Incision and draining the boil plus a course of anti-MSSA (methicillin-susceptible Staphylococcus aureus... MSSA) drugs. Staphylococcus aureus is associated with the common staph infections patients get in hospitals. Recently an antibiotic resistant strain has appeared in the United States (MRSA) and is giving the anti-antibiotic movement some serious reason for concern. The fear is that the emergence of MRSA represents the preamble to an age of "superbugs," the drug-resistant strains that get created by natural selection when antibiotics are overused. Hence, there was some interesting discussion on the NEJM forum regarding that very topic.
Hammond and Baden followed up the case study with the results of their poll and some analysis. One of the most interesting points to the article was an interactive map showing how doctors, students, allied health care professionals and "others" voted based on country. Over 11,000 people representing 124 countries weighed in on the case and responses varied by geography. In the article the authors state "Participants in North America favored incision and drainage plus anti-MRSA therapy (53%); those in Asia and Russia and South America favored incision and drainage plus anti-MSSA therapy (49 to 54%); and those in Africa, Australia and Oceania, and Europe were largely split between incision and drainage alone (36 to 45%) and incision and drainage plus anti-MSSA therapy (34 to 42%)." It appears that, depending on where you live and who you believe, either your risk for catching an anti-biotic resistant strain of Staph is greater (i.e. North America) or your doctors are just more worried about it.

A closer inspection of the numbers (see table) reveals that the NEJM is not telling the entire story. For instance, the range and "split" between European nations doesn't look right at all. Close inspection of the interactive map provided shows that some European nations such as The Netherlands, Sweden, and Norway voted as high as 79%, 69%, and 73% in favor of lancing and drainage alone. In fact the average preference for voters in the WHO's Top 25 health care systems was for incision & drain (47%), followed by incision & drain with anti-MSSA (34%) and incision & drain with anti-MRSA a distant third (19%). Three of the top 25 countries (San Marino, Andorra, and Monaco) were not represented by voters, but of the remaining 22, 18 are European nations. If those countries are assessed as a 'European' block, the number of responders who prefer incision and drain alone for the case jumps to 51%.
The bigger question is why the difference between worldwide and North American (55% of whom preferred incision & drainage with anti-MRSA medication) responses for a case involving an otherwise healthy college athlete. The skewing of the data based on a higher North American response rate would lead a reader to believe that anti-MRSA therapy was more popular worldwide by a thousand votes. However if you look at the breakdown of votes by continent, North America is the only place where anti-MRSA therapy was more popular than incison and drainage without anti-biotic. If MRSA has become such a threat in North America because of this strain of Staph's adaptation to the most commonly prescribed anti-microbial, wouldn't it make sense to stop this trend in its tracks, especially in a case involving someone with an apparently fully functional immune system?
References:
Chambers HF, Moellering RC Jr, Kamitsuka P (2008). Management of skin and soft-tissue infection. New England Journal of Medicine 359 (10) pp 1063-1067.
Hammond SP, Baden LR (2008). Management of Skin and Soft-Tissue Infection — Polling Results. New England Journal of Medicine 359 (15) p e20.