WhiteCoat

You don’t use Raid on dandelions …

Here’s another fine mess you’ve gotten me into (that’s a blast from the past for all those old-time TV buffs).

It seems that you can’t change the channel, surf a web site, or turn the page of a magazine lately without hearing about the “superbugs” that are invading everyone’s bodies – even our ears!

Bacteria develop resistance similar to the way that humans develop resistance. Expose yourself to an infection and your body figures out how to protect itself from the infection in the future. Get chicken pox once and you probably aren’t going to get it again. Your body has learned to adapt. Immunizations and flu shots are nothing more than weakened forms of the infections we are trying to prevent.

So how did the superbugs develop? Perhaps an oversimplification, but they developed by being exposed to antibiotics over and over again. The weak bacteria die and the stronger ones multiply. Eventually the stronger ones develop a resistance to the antibiotics. Then, once some bacteria learn how to beat certain antibiotics, they’ll trade their secrets with other bacteria. It doesn’t happen overnight, but it does happen.

The superbugs kill more people than AIDS. They’ll eat your skin and wither your brain. And guess what, folks – they’re all our fault.

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Patients:
Next time you request demand an antibiotic for a “sinus infection” that is nothing more than a congested nose, or for a sore throat because “it always turns into strep,” you, John Q. Public, are causing the development of resistant organisms. Take a sugar pill because it works just as well and costs one hell of a lot less.
Every time that you only take a couple of days of your antibiotic prescription because you’re feeling better, the millions of bugs you haven’t killed off are learning how to beat those antibiotics the next time. At some point, when you really need them, your “miracle cure” antibiotics won’t work any more.

Physicians:
When you prescribe antibiotics for rotten teeth, toothaches without abscesses, bronchitis, coughs, and colds, you’re not doing good, you’re doing harm. A lot of harm. I even have an issue with prescribing antibiotics for ear infections, even though I know I’m in the minority on this one. But before you write me off as an extremist, answer this question for me: How is it that a tooth abscess that swells up the entire side of someone’s face doesn’t cause a fever, but an abscess the size of a pencil eraser behind the eardrum causes a fever to 103 degrees? Sorry for the tangent. I’m in rant mode. But I still would like an answer to that question.
What’s the harm, you ask? Not every patient has an extra $150 to shell out for a course of Levaquin or Augmentin — especially when there is no medical basis for prescribing it. That’s a week’s take-home pay for some people.
Those unnecessary antibiotics also cause side effects. Some of those side effects can be life-threatening. I have seen more than a few cases of Stevens Johnson Syndrome and at least one of them was caused by an unnecessary antibiotic prescription for “sinusitis” that had miraculously been cured the following day with a few doses of Bactrim.

So patients, protect yourselves.

  • If your doctor won’t educate you, educate yourselves. Instead of requesting antibiotics, go to WebMD or eMedicine.com and look up your symptoms. Become smarter than your doctor about these diseases if necessary.
  • For nasal congestion, most coughs, many sore throats, muscle aches, and the flu, antibiotics will not help you! Ask for antibiotics if you want, but why not send your money to a favorite charity instead of making Big Pharma more wealthy? At least if you send your money to charity, you’ll feel good about yourself.
  • And ask your physician when the last time he or she washed his or her hands. Tough crap if they are offended. You’ll be more offended if you get infected with a superbug because they haven’t done so. Hospitals are dirty places.

Physicians, instead of providing inappropriate antibiotic prescriptions, take the time to teach your patients.

  • Help patients to help themselves. My favorite line to patients requesting unnecessary antibiotics is this: “Using antibiotics on virus infections is like using Raid on dandelion infestations. Both chemicals kill things, but neither one is able to kill the things we’re trying to get rid of. Your body is going to have to fight this one out on it’s own, but I’ll help you control the symptoms while it does.”
  • Oh, and wash your hands once in a while.
  • While you’re at it, wash your stethoscope once in a while, too.

Want to know why I’m so passionate about this topic? My daughter nearly died from a strep infection a few years ago. She was in the hospital for 10 days. Fortunately there were some antibiotics that still worked to help cure her. Given her medical problems, I wonder whether we’ll be so lucky if there is a next time.

Anyone reading this could be the next victim.

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UPDATE

An interesting article on the development of MRSA was recently written in the Chicago Tribune. I have included a copy of the text of the article below in case the link goes dead.

How staph became drug-resistant threat

94,000 infections a year, many occurring outside of hospitals

|Tribune staff reporter

The evolutionary path of the bacterium called MRSA wound around the globe for decades before a pair of Chicago doctors in 1996 noticed the bug had taken an ominous turn.

Before then, the germ’s resistance to antibiotics was of concern mainly in hospitals, where steadily growing numbers of patients were contending with the stubborn staph infection. Reports of healthy people who contracted MRSA outside of a hospital were rare and isolated, the stuff of obscure medical journal articles.

But the bacterium, formally known as methicillin-resistant Staphylococcus aureus, was beginning to depart from the habits it had settled into during years of adaptation to human hosts.

 

 

Related links

At the University of Chicago Medical Center, pediatric specialists Dr. Robert Daum and Dr. Betsy Herold held an impromptu meeting to discuss a dramatic increase in young patients showing up at the hospital with MRSA infections they’d gotten in the community. Dozens of children were sickened by the resistant bacteria without having contact with hospitals — an unprecedented outbreak.

“We just looked at each other and said, ‘What’s going on here?'” said Daum, chief of pediatric infectious diseases at the U. of C.

They were witnessing a pivotal episode in the biography of a bacterial family that is now found widely in hospitals and among the public at large, causing 94,000 severe infections each year with 19,000 deaths, according to a recent federal estimate. From its humble birth at hospitals in Britain, MRSA has transformed itself into a menacing microbe with fewer weaknesses and perhaps more lethal power than its ancestors had.

The germ’s years of adaptation did not make it an invulnerable superbug. Some antibiotics still work reliably against MRSA and even severe cases of illness can be treated. But many doctors still do not know how to recognize and properly treat the infection, and experts are concerned potent strains will continue spreading in the community.

The bug’s erratic evolutionary story became clear only in the last few years as scientists decoded the full genomes of at least 12 separate staph varieties, making the bacteria among the most intensely studied pathogens in recent memory. Genetic sleuthing has revealed MRSA’s family ties and some potential gaps in its armor, as well as the darker corridors of its private life.

Like most successful germs, MRSA has triumphed by constantly changing and adapting to new environments. MRSA does this mostly through an uncanny talent for weird bacterial sex.

It’s not sex as humans understand the term, but the effect is the same: a blending of genes from unrelated individuals. MRSA does it with the aid of viruses that siphon DNA from an individual germ and inject it into the next, like microscopic mosquitoes. The bacterium also has the ghoulish ability to suck up genetic material from germs that have died and dissolved.

“This isn’t like human biology at all — after we’re born we’re stuck with the genes we’ve got,” said MRSA researcher Dr. Henry Chambers, chief of infectious diseases at San Francisco General Hospital. “Staph can take on new genes and share them with friends.”

The bacterial ancestors of MRSA have probably stalked humans throughout history. Staph is an ancient, ball-shaped germ that caused skin inflammation and battlefield wound infections long before it encountered the antibiotics that helped spawn MRSA. Scientists identified Staphylococcus aureus as a species in the late 19th Century.

Staph felt the sting of antibiotics before any other bacteria, when British researcher Anthony Fleming discovered penicillin stopped the germ’s growth. By the 1950s, however, the bacterium had adapted by making an enzyme that could slice through penicillin. The need for more antibiotics led to a new wave of drugs, including the debut of methicillin in 1959.

Just one year after methicillin hit the market, a young English bacteriologist named Patricia Jevons was testing thousands of bacterial samples and found three strains were resistant to the new drug. Reporting her findings in the British Medical Journal in 1961, Jevons noted calmly, “The fact that the occasional resistant strain does exist should be borne in mind.”

No newspaper headlines heralded the birth of MRSA, perhaps because experts already knew it was only a matter of time before staph figured out the new drug. Antibiotics shove bacteria into an evolutionary corner, weeding out the vulnerable varieties and offering an opportunity to strains that have picked up key defensive traits.

“We can always expect antibiotic resistance to follow antibiotic use, as surely as night follows day,” said Dr. John Jernigan, a medical epidemiologist with the federal Centers for Disease Control and Prevention.

Evolution’s answer to methicillin was a gene called mecA that allowed MRSA to evade the antibiotic’s molecular weaponry. Scientists searching for its origins have found different versions of the gene in a form of staph that infects rats, as well as in a relatively harmless type of staph that can be found virtually everywhere.

The resistance gene likely hopped repeatedly from one staph species to another, perhaps using the bacterial viruses called phages as its taxi service. The gene “wasn’t very common, but it was there in the background, waiting to be amplified,” Chambers said.

Landing in the U.S.

MRSA spent its youth in the ’60s lurking in the shadows, slowly spreading and gathering force. The bacteria got its U.S. passport in 1968, when the first American cases showed up in Boston. Methicillin fell out of use as a drug because it was toxic to some patients, but MRSA was still resistant to the similar drugs that replaced it.

Then, as today, doctors could still stop the bug with a more powerful antibiotic, vancomycin. But if an infection is not recognized as MRSA, the patient’s condition can get dangerously worse while a physician tries to treat it with weaker antibiotics. Doctors typically do not reach first for vancomycin because routine use of the drug could help bacteria build resistance to it as well.

As of 1974 the resistant bug still accounted for only 2 percent of all hospital staph infections. The problem in hospitals grew more quickly in the 1980s before flattening out. MRSA took off first in big-city teaching hospitals, which brought together large numbers of the sickest patients from around the world. Once the bug gained a foothold, it seemed almost impossible to eradicate.

“It’s not as though we can point to one organism at one location and say everything emanated from here in logical fashion,” said Fred Tenover, acting director of the CDC’s office of antimicrobial resistance. “We had progressions, fallbacks; then the bacteria reached a critical mass, got a foothold, and from there you got larger and larger epidemics.”

Scattered cases of MRSA cropped up outside of hospitals in Michigan and parts of Australia, but before the 1990s, resistant staph never quite caught on in the community.

Pressures of evolution

The reason may go back to the selective pressures of evolution. Drug resistance doesn’t always help bacteria survive. It’s vital for germs in a hospital, where the constant use of antibiotics slowly weeds out any bacteria that lack such defenses, but in the community, resistance genes may become a drag.

“Having this extra baggage can take away from the bacteria’s fitness, so it’s better for the bug not to have it,” said Susan Boyle-Vavra, a staph researcher at the University of Chicago.

That’s one reason the U. of C. finding of a spike in community-acquired MRSA cases came as such a shock when Daum’s team published its results in 1998. Another was that no one had seen this strain of MRSA before. Among other clues, the U. of C. strain could be treated with drugs such as clindamycin, which the common forms of hospital MRSA had learned to resist long before.

Daum began sounding an alarm about the new form of community MRSA, but few people in the media or in the research community took his concern seriously. Community MRSA still seemed rare, and the hospital variety was a bigger problem. Jernigan was one of many experts who argued the new bug had merely escaped from hospitals and posed no unique threat.

“Early on, I wondered if MRSA in the community had its origins in the health-care setting,” Jernigan said. “That was wrong. It definitely has its own foothold in the community.”

The unusual properties of MRSA’s new form have emerged since 2000 as scientists intensely studied the bug.

Troubling toxin

One of the strain’s most potentially troubling features is a gene for a toxin called PVL, which hopped a ride into the staph genome on a bacterial phage. The toxin’s role has spurred debate, as some researchers think it’s merely a benign passenger. But some studies suggest MRSA with PVL can cause more serious forms of disease, including a severe form of pneumonia.

“If you have bad staph pneumonia, you’re likely to have a strain with PVL,” Daum said. “It’s a convergence of drug resistance and virulence.”

An even newer strain of community MRSA has swept the country in the last few years and now accounts for nearly all cases. The latest variety appropriated yet another gene from a mostly harmless type of staph that may be helping the new strain spread.

“It can survive inside the cells the body normally uses to kill it,” Tenover said. In the latest twist to the story, scientists say the community strain now has begun infecting hospital patients, who may be more vulnerable to it.

Genetic studies of MRSA have brought some good news. Last year researchers from the U. of C. and Rockefeller University in New York reported a successful test in mice of a vaccine that would protect against several forms of MRSA, including one of the community varieties.

It may even be possible to make old antibiotics work against MRSA. Daum’s lab has focused on disabling a system of proteins in the bacteria that sense when antibiotics are nearby. Turning off that system makes the bug blind to the drugs that can kill it.

If successful, the approach one day could allow doctors to use standard antibiotics even against germs that possess the resistance gene. For once, MRSA’s long evolutionary march could take a welcome step backward.

– – –

Avoiding infection

Good hygiene is the best way to avoid infection with MRSA. This staph infection sometimes first appears on the skin as a red, swollen pimple or boil that may be painful or have pus. It can be spread by close, skin-to-skin contact or by touching surfaces contaminated with the germ. The federal Centers for Disease Control and Prevention advises:

* Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand cleaner.

* Keep cuts and scrapes clean and covered with a bandage until healed.

* Avoid contact with other people’s wounds or bandages.

* Avoid sharing personal items such as towels or razors.

Associated Press

– – –

Tracking MRSA in hospitals and communities

Resistant strains of Staphylococcus aureus have evolved steadily over the years and acquired the ability to spread through the community. Today about 2.3 million Americans carry MRSA in their nose or on their skin.

TIMELINE OF MRSA

Methicillin-resistant Staphylococcus aureus

1959: Methicillin is introduced as an antibiotic.

1961: Bacteriologist Patricia Jevons discovers first methicillinresistant staphylococcus aureus (MRSA) in England hospitals.

1968: First report of MRSA in American hospitals in Boston.

1974: MRSA accounts for 2% of hospital staph infections in U.S.

1981: First reports of MRSA acquired in the community, while MRSA in hospitals rises steadily.

1997: MRSA accounts for 50% of hospital staph infections.

1998: University of Chicago researchers report a 25-fold increase in community-acquired MRSA from 1993 to 1995. During the same period, 35 kids in Chicago are hospitalized with community-acquired MRSA.

1999: CDC reports deaths of four otherwise healthy children from community-acquired MRSA.

2002: U. of C. team finds that new cases of community-acquired MRSA are genetically distinct from hospital strains.

2007: CDC estimates that MRSA causes 94,000 severe infections each year, killing 19,000.

Sources: CDC, University of Chicago, Barry Kreiswirth for The Public Health Research Institute Center

Chicago Tribune

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17 Responses to “You don’t use Raid on dandelions …”

  1. rlbates says:

    Good post! Needs to be said over and over.

  2. kitty says:

    I second that. Having grown up outside the US, the only time I had antibiotics as a child was when I had a bactrerial pneumonia, and a bad one at that. Even though medicine there was much worse than in the US, everyone, not just doctors, knew that antibiotics have side effects and should not be taken without a very good reason. I guess doctors drilled it into our heads; otherwise, how would we had known?

    First time I came to a doctor in the US with what turned out to be a bad case of bronchitis, the doctor gave me antibiotics. (No, I hadn’t asked for them). After dutifully taking them for a week and not feeling any better (why can’t I ever feel placebo effect?) but getting diarrhea, I came to a doctor again. When he gave me another antibiotics, I asked him if it would do any good. He told me probably not because it is likely to be viral. So I asked, why take it then? He told me it is up to me. I told, no thanks.

    I think that the fact that people demand antibiotics is because they were conditioned to believe that they help. Most lay people don’t understand that antibiotics don’t work on viruses. If the doctors had never prescribed antibiotics for colds to begin with, how would people know to ask for them? I also think that sometimes doctors prescribe antibiotics because they think we want them. At least in my case this was true.

    Incidentally, IMHO, information about possible side effects is a lot more likely to work on people who demand antibiotics than explanations about resistance. An immediate risk of something bad happening to you personally, however small the risk is, is always more convincing than something that may happen to you in future or to someone else.

    I am curious. What is your take on periodontists prescribing antibiotics for a week before surgery? Is it justified? My periodontist always does it. What about dentists prescribing antibiotics to elderly before dental work? Just curious.

  3. EEJ says:

    So I just got back from a 2 week vacation in Europe, and came back with a nasty chest/sinus cold. After a week of dealing with the symptoms with OTC medications, I decided to head down to my local doctor, just to make sure it wasn’t pneumonia or something.

    He looked at my throat, and then listened to me breathe, asked me what color my mucus was (mostly green), and promptly gave me 2 prescriptions: Zithromax (Z-pack) and Cough medicine.

    When I inquired if the antibiotic would help, he stated “Only if what you have is not a virus, but with the symptoms lasting this long, it’s your only option”. When I asked if the prescription cough medicine was any better than over the counter, I was told “probably not, but you do have a bad cough, and need to take something for it”.

    I’m taking the antibiotics, so we’ll see if there’s any improvement, but I doubt I really needed them. At least it only cost me $7, as they have a generic version available, and I didn’t bother to fill the cough medicine prescription.

    Sidenote: When I told the nurse I didn’t want to take the cough prescription, she said “Hang onto it, it’s good for six months, and you might get another cough”. Wasn’t that nice of her? (sarcasm intended)

  4. dianarn says:

    I totally agree with you, except on the no antibiotics for ear infections statement. I’ve had a ton of those when I was a child and they are a bitch. I lived in Romania at the time and over there, I’m pretty sure antibiotics are OTC because everyone had a few boxes of erythromycin and ampicillin lying around. I had a neighbor here in the US, whose little 5 year old daughter kept having ear infections almost every few weeks and her physician wouldn’t give her any antibiotics. It was horrible seeing her in so much pain, especially since I know exactly how painful it is. He finally relented and gave her some. She finally stopped having them after that.

    I think American doctors are a little more wary about prescribing antibiotics than European ones, which is good. They also do more teaching about when to take them and when not to. That’s definitely more than over yonder in Europe. To this day, my mom still cannot comprehend antibiotics are useless against viruses.

    I also think that not only should we be wary of taking antibiotics when we’re not supposed to, but we should also be careful of what we eat. 70% of antibiotics made in the USA are given to healthy farm animals as prophylactics. This is done in the big agro-farms just because the animals live so close together in filthy conditions. So instead of keeping things cleaner, they shoot them full of antibiotics, so they don’t develop infections. I’m sure that creates drug resistance in bacteria just as much as taking antibiotics for a couple of days for no reason does.

  5. kjpierce says:

    I completely agree with your take on the overuse of antibiotics – I only ask for them when I get a “real” sore throat and after I’ve had a strep test done (I have a history of chronic strep throat and the only time I get a sore throat is when I have strep). But what about the overuse of all of the anti-bacterial products available at one’s local store – hand sanitizer, dish soaps, etc. I’m no doctor, but I think that using straight soap and water works just as well and doesn’t contribute to bacteria becoming drug resistant. (Perhaps my logic is flawed?) Far too many people have become germ-phobic to the point of ridiculousness.

  6. SeaSpray says:

    Powerful post!

    I have a friend who had a rash appearing on her lower extremities. She described it to me as looking like cigarette burns. She also had been ill for awhile with a sore throat. She didn’t go to her doc until it started appearing on her buttock area.

    He diagnosed it as scabies and told her what to apply to it.

    1st of all, it isn’t likely that she would have come in contact with anyone who had scabies-not professionally or in her private life and by the time she saw that doc…the entire family would have had them.

    She applied the medication and was having excruciating burning pain. Her Doc’s office couldn’t fit her back in and she ended up seeing a local pediatrician (per a friend’s request)as an “off the record” eval and he said what he thought it was and suggested she go to a certain dermatologist. HE…took her right in and told her that if she had waited one more week…she would have been dead. The pediatrician’s dx was the correct one (I don’t remember what it was)and she was put on antibiotics for quite a while. Oh and it was caused because her sore throat that she was weathering out was actually strep that had progressed in her system. Her ankle was necrotic and she had to continue her visit for treatment for 3-4 months.

    How did one doc dx as scabies when 2 others obviously diagnosed it correctly? They dropped the private doc.

    The only time I have ever asked for antibiotics is for a UTI and then it cleared up. I think you can tell because you get progressively worse with symptoms. But docs have given me antibiotics for bronchitis and sinusitis and the sputum went from green to clear and I had a marked change in how I felt.

    My question is: Are you saying these things would have run their course (worse before better)and antibiotics are never needed for sinusitis or bronchitis? I did hear someone say once that just because sputum is green does not necessarily indicative of a bacterial infection. Is that true?

    i worked with an ER doc once who said he was friends with a pulmonary doc who named his dog Phlegm. Too funny! GROSS but funny! :)

  7. Dr. Kranky says:

    re the ear infection thing:it’s worse. A frightening number of those infections are in ears that on careful examination are NORMAL. hmmmmm

  8. lpnmon says:

    And hey docs, after you’ve washed your hands, maybe you could swipe your stethescope off? When was the last time you saw anyone wash their ‘scope? I’m guilty of this too. And yeah, how about those antibacterial soaps and whatnot? DO they contribute to superbugs?

    Great post!

  9. Anasmom04 says:

    This topic makes me crazy. I have had this debate with my mother-in-law over and over again… And she’s a nurse, a NURSE! She harangues the doctors she works with into giving her antibotics everytime she “feels a cold coming on.” I wish they would grow a spine and tell her NO. I asked her why, if what she had is likely a virus and antibotics, we know, do not cure viruses, would she want to take them? “Oh,” she says, “They just relieve my symptoms.” Really?? I didn’t know antibiotics were pain relievers, antihistamines, fever reducers, anti-inflammatories, etc!

    One time she lied to a doc she works with to get her drug of choice, Z-Pak, to give to us (completely unsolicited) which is not only stupid medically speaking, it’s fraud because she used her insurance to pay for it! What a waste. It expired before we had any use for it.

    How is it that even doctors and nurses don’t seem to get it???

  10. dianarn says:

    Lpnmon – same thing goes for nurses. I usually wipe the stethoscope with rubbing alcohol between each patient, but if they’re in isolation we use those yellow toy-looking stethoscopes. I can’t say everybody does that, though. I’ve seen some really dirty stethoscopes before. The antibacterial soaps contain Triclosan, which supposedly in hospitals is in a greater concentration than say, the antibacterial soaps you buy at Bath & Body Works. I think that regular soap and water is just as good if you rub your hands well and long enough. Alcohol sanitizer is also good, but it doesn’t kill C-diff.

    Dr Kranky – can ears not be infected and the person still experience a lot of pain? That’s what always got me… the only thing that helped the pain was really hot pads on my ear.

  11. WhiteCoat says:

    Prophylactic antibiotics shortly before surgery are proven to decrease the amount of intraoperative infections. But usually it is one dose shortly before surgery, not a week’s worth of medication. Tell your doctor you read something on the internet about this and your doctor for his reasoning.
    LPNMON has a good point about stethoscopes. I added it to my rant. Thanks.
    SeaSpray, antibiotics are useless for bronchitis. Do a Google search using the terms “antibiotics” and “bronchitis” and see what you come up with. Here’s just one link: http://abcnews.go.com/Health/story?id=2656438&page=1
    Antibiotics are necessary for true sinusitis, but most cases of sinus congestion are called “sinusitis” without meeting the diagnostic criteria for sinusitis. Next time you get sinus pain, take a couple of hits of some Afrin or Neo-Synephrine (or their store-branded equivalents) and see how quickly your symptoms go away.

  12. SeaSpray says:

    Thank you Whitecoat-I read the article. I appreciate this post! thank you for answering the questions. I am trying to understand the criteria for determining when antibiotics ARE indicated, so I do have a few more questions.

    I haven’t had sinusitis in over a decade and I wonder if I truly had sinusitis? I went to the doc because of an increasingly sore throat (I know a drip can irritate the throat), feeling feverish with a low grade fever and dark green sputum that tasted awful. However, I have never in my life felt sinus pain like I have heard other people complain about. But the doc I had at the time did call it sinusitis. Either way…after a couple of days of antibiotics..I did start feeling markedly better.

    Are you saying ..that I would have anyway? Can the viral infection turn bacterial? Is green sputum always an indicator of bacterial? What about foul tasting sputum? (GROSS!) And finally, I have always given an infection time before running off to the doc (because I DO know better) and so if it felt like it was getting worse after already being sick for a while that is when I went to get checked.

    My PCP did diagnose me with bronchitis 6 yrs ago. I was weak/sick..you know… how a uri can totally drain you? The coughing was unnerving because it was so deep and sometimes felt like I wasn’t going to get my next breath because I couldn’t stop. You can’t lie down. Always feeling like you need something to break through the congestion but nothing works. (I never did use a humidifier though and the heat was on)It was getting progressively worse during the week and so I saw my PCP that Thursday and he diagnosed as bronchitis, gave me a script for antibiotics, cough medicine and an inhaler. I never used an inhaler before but it did help. I went in to my ER reg shift on Saturday but saw the ER doc on the side when there was a lull. (One of the perks of working there) He listened to my chest, etc. and when he saw that I had been given an inhaler.. he took it out of my hands, looked at it and then said somewhat irritated (not at me), “You DON’T need THIS!” I didn’t question him as to why, but I did stop using it because I didn’t want to set myself up to be dependent on something like that.

    Our sons have been healthy and so the trips to the pediatrician have been minimal. I got to know him first through working at the hospital and so when I felt the boys needed an antibiotic I would call him and describe the symptoms and he called in an order for an antibiotic/cough medicine and the boys improved. I never just ran for the drugs but I just kind of knew based on symptoms and he must have trusted my assessment.

    *I have always found it interesting that considering the number of sick patients that come in to the ER, that the staff by comparison really doesn’t succumb to all the exposures to illness. You’d think we’d all be sick every other day, but it really doesn’t work like that. (My observation anyway :))

  13. misspudding says:

    Oh, I am so conflicted on all of this. I am so anti-antibiotics, but my son (he’ll be 3 in December) gets chronic sinusitis with recurrent pink eye/ear infections. He’s had a bazillion food allergies (wheat, dairy, corn and soy) but tested negative for all of the environmental ones. His allergist gave us some nasal corticosteroids to follow up after his infections and that is the only thing that’s helped, over the long term.

    We still have to use antibiotics to get it to clear up. Luckily, amoxicillin does the trick, every time. Unfortunately, we’ve been told that “waiting it out” won’t really work in his case.

    What’s a mom to do? I nursed for 20 months…I’m not nursing him until he’s twenty. :)

  14. Dr. Kranky says:

    Dianam: In adults (and most kids over age 5) a cardinal complaint of ear pain should prompt the doctor to look ELSEWHERE. In other words, chances of your ears causing the ear pain (what we refer to as “referred otalgia) are probably less than 5%. In healthy adult females, it’s almost always a TMJ problem (especially due to gum chewing in teenage girls)- a rare finding in men. Older adults of both sexes have referred otalgia most commonly from degenerative conditions of the cervical spine (along with TMJ in older women).

    Sea Spray: you had a smart doc who diagnosed the sinusitis (if in fact the symptoms were going on for an extended period of time). “Sinus Pain” is RARELY present in true sinusitis. It’s a garbage can term used by Big Pharma to sell you worthless OTC “Sinus” meds,” and a term much beloved by the ignorant (of both a lay and professional stripe). If you talk with patients from other countries they never speak of “sinus pain,” because it’s simply not in their vocabulary. Consequently they’re not nonchalantly prescribed antibiotics for their “sinus infections” the way that demanding, ignorant and/or misinformed Americans are.

  15. SeaSpray says:

    Thank you Dr Kranky :)

  16. IDPharmD says:

    This is why the world has antimicrobial stewardship/ ID clinical pharmacists :-)

  17. KM Taylor says:

    I know this is an old post, but on the off chance that you’re still reading the comments when they come in, I wanted to thank you for this simple and wonderful (and fun!) analogy to use when explaining to patients why we won’t prescribe antibiotics for their sniffles.

    I found this link in comments to a current post at KevinMD and have now bookmarked it so I can pass it around.

    Great writing!

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