Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
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Free antibiotics are bad?
24 Jun2009
I have a recent history of disagreeing with IDSA – Pharyngitis Management: Defining the Controversy. They have outdone themselves in my opinion.
Free Offers of Antibiotics Raise Concern for Some in Public Health: Resistance Feared
I do a significant amount of attending at a community hospital. We serve insured patients and “safety net” patients. Given the significant number of patients who we discharge on antibiotics and the inability of many of them to pay, the free antibiotic option is a blessing. Ask any of our attending physicians or residents and they love this option.
The free antibiotics:
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Amoxicillin
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Cephalexin
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Sulfamethoxazole/Trimethoprim (SMZ-TMP)
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Ciprofloxacin (excluding ciprofloxacin XR)
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Penicillin VK
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Ampicillin
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Erythromycin (excluding Ery-Tab).
I cannot see any bad here. Free antibiotics decrease the tendency to use newer more expensive options, reserving them for resistant organisms.
But here comes the IDSA:
Promoting free antibiotics at a time when the nation faces a growing crisis of antibiotic resistance “does not make good public health sense,” according to the Infectious Diseases Society of America, which criticized the giveaways.
“Most doctors know better than to prescribe antibiotics when they are not needed,” said Anne Gershon, MD, president of the Infectious Diseases Society of America. “But many find it hard to say ‘no’ to sick patients who think antibiotics will make them feel better. We are concerned that these pharmacy marketing efforts will encourage patients to ask for antibiotics prescriptions.”
Antibiotic resistance is “one of the key microbial threats to health in the United States,” according to the Institute of Medicine, which has recommended curbing the inappropriate use of antibiotics — such as using them for illnesses they do not treat, like colds or the flu, or using them to enhance growth among livestock.
I may get in trouble for this post because I am going to say what I really feel. I have removed my frontal lobe for the next few minutes.
The IDSA is consistently critical of outpatient antibiotic use. In the hospital, confronted with a sick patient, infectious disease specialists often become very liberal in antibiotic use.
I believe the problem is a lack of respect for outpatient medicine. This list of antibiotics helps my patients actually take their antibiotics. Money does matter.
I am astonished that IDSA has made this an issue. I wonder if they also object to $4/month prescriptions.
Still shaking my head in disbelief.
db putting frontal lobe back into cranium – signing off
Related posts:
- Is there a downside to free?
- Antibiotics for strep throat?
- Whether to prescribe antibiotics for bronchitis
- Resist unnecessary antibiotics
- 15 days at the VA – day 10
Related posts brought to you by Yet Another Related Posts Plugin.
- In: Medical Rants
7 Responses to Free antibiotics are bad?
A Skeptic
June 24th, 2009 at 11:30 am
I disagree with you. You need to practice in the community to realize that unfortunately free antibiotics equals antibiotics for everybody. Removing the monetary disincentive increases the expectation for antibiotics to be prescribed for every upper respiratory infection. Forget the problem of resistance. What about the unnecessary cases of C. difficile colitis or other adverse effects? Just as some of us were starting to make headway against the incessant, irrational antibiotic demands, these free antibiotic programs have put us back to square one.
madhu
June 24th, 2009 at 1:09 pm
I had not thought of things the way you did.
I work for the VA as an outpatient internist and recently one of my patients got admitted to a community hospital with “urosepsis” and was discharged on Bactrim and Levofloxacin. The gentleman told me that Levo would cost him about $75 for about 5 doses. Since I did not have any susceptibility data so I sent off a urine m,c and s and gave him Bactrim to complete his course.
Free antibiotics are bad, if they lead people to overuse antibiotics inappropriately. And your point about antibiotics in hospital is well taken and true in my experience as an occasional in-patient attending.
Clinton
June 24th, 2009 at 4:41 pm
I don’t quite know how to express this, but I get bothered by the “broad-spectrum -> narrow-spectrum” antibiotic use. If you take a broad-spectrum antibiotic for just a day or two and switch it over to a more specific antibiotic for a full course of treatment…. doesn’t that mean that there is an inadequate dose of broad-spectrum antibiotic being administered and thus, other bacteria NOT targeted by the narrow-spectrum antibiotic would have been selected to develop resistance to the broad-spectrum antibiotic?
I don’t know what the solution to this theoretical problem would be.
Obviously, it makes sense from a clinical framework to start with empiric antibiotics and narrow the regimen so it is specific to the disease… but is this a myopic way to look at things when the pathogenic bacteria isn’t the only bacteria that is undergoing evolutionary pressure?
Rich
June 24th, 2009 at 6:21 pm
The US is a small part of the worldwide human-bacteria ecosystem. In the typical groupthink ranting against profligate use of antibiotics by primary care doc’s, I have never heard anyone raising concern about the fact that in Mexico, or Central America, and possibly beyone, one can purchase antibiotics from ‘la pharmacia’ without a prescription. Yet, those from south of the border don’t seem to carry resistant organisms with them to the US. So, does this ”overuse of antibiotics south of the border offer a way to compare semi-controlled prescriptions against open access??
(signed – Just a general surgeon.)
AnnR
June 25th, 2009 at 6:09 am
I think Rich has a good point.
Billy Rubin
June 25th, 2009 at 7:39 am
I don’t see it as disrespect for the outpatient physician. You note that “in the hospital, confronted with a sick patient, infectious disease specialists often become very liberal in antibiotic use,” which is true, but that’s because they’re sick !
On the other hand, of the free drugs you list above, at least one of them (Cipro) has gone from being a first-line agent for gram-negative infections to, in the colorful words of one of my colleagues, a “piece-of-shit drug” due to widespread resistance (say, E. coli in UTIs among other conditions). I might not go that far but I’ve watched fluoroquinolone resistance go from virtually nothing when I was a trainee to about 20 or 30 percent now, and I’m not that far out of training.
I don’t know if opposing free abx is the answer, and your point that maybe there’s a culture gap between the ID and the primary care docs is well taken. Perhaps the answer lies in getting everyone , both outpatient and inpatient docs, to curb the use of either unnecessary or broad-spectrum antibiotics. But I can tell you this from an ID doc’s perspective: Dr. Gershon of the IDSA is pointing out that there’s a big problem out there, and it’s only getting worse.
Myrtle
June 27th, 2009 at 8:49 pm
Rich brought up exactly the question that I’ve had for a long time. Why is it believed that antibiotic resistant strains originate within the US and not some other country in which antibiotics are over the counter?