Comments on: You don’t use Raid on dandelions …

By: KM Taylor

KM Taylor — Fri, 15 Mar 2013 14:36:02 +0000

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!

By: IDPharmD

IDPharmD — Tue, 11 Jan 2011 23:00:03 +0000

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

By: SeaSpray

SeaSpray — Mon, 22 Oct 2007 05:37:39 +0000

Thank you Dr Kranky

By: Dr. Kranky

Dr. Kranky — Sun, 21 Oct 2007 23:25:07 +0000

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.

By: misspudding

misspudding — Sun, 21 Oct 2007 02:48:14 +0000

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.

By: SeaSpray

SeaSpray — Sat, 20 Oct 2007 17:45:37 +0000

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 )

By: WhiteCoat

WhiteCoat — Sat, 20 Oct 2007 15:24:02 +0000

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.

By: dianarn

dianarn — Sat, 20 Oct 2007 04:45:18 +0000

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.

By: Anasmom04

Anasmom04 — Sat, 20 Oct 2007 04:44:57 +0000

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???

By: lpnmon

lpnmon — Sat, 20 Oct 2007 00:46:13 +0000

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!