WhiteCoat

Microbial Armageddon

Any patient who demands a ZeePack for a runny nose, who wants amoxicillin for sinus congestion, or who wants Levaquin to “keep this bronchitis from developing into pneumonia” needs to read this Bloomberg article.

We are heading toward a situation where people die from infections that no antibiotics can treat. The article discussed one infant in a pediatric ICU that died because the infection that the child developed was resistant to all antibiotics used for treatment. Six similar incidents occurred during the course of 16 months. Estimates are that 100 million people in India have been colonized with organisms carrying the genetic mutation. Medical tourism in India is decreasing as a result.

Even the director of the CDC cites the situation an example of why we have to limit antibiotic prescriptions: “We are looking at the specter of untreatable illness.”

Oh, and remember how the Centers for Medicare and Medicaid Services assert that if hospitals don’t give antibiotics to every single pneumonia patient within 6 hours of arrival – even though a large proportion of pneumonias are viral in nature – that the hospitals are falling outside of “quality” guidelines? Our government’s own “quality” guidelines may be contributing to the looming microbial Armageddon in this country.

19 Responses to “Microbial Armageddon”

  1. [...] on “Microbial Armageddon” from WhiteCoat’s Call [...]

  2. DaddyBear says:

    When I go to a doctor with a head cold or sinus infection or whatever, I don’t ask for medication. I describe what I am feeling, let the doctor make the diagnosis, and then she can tell me what I need to do. I’m immunocompromised due to the medicine I take for arthritis, so my MD might be more pro-active with antibiotics on me than with other patients.

    Is this something the AMA needs to start educating its members on, as well as doctors being more firm in telling their patients that antibiotics aren’t a good idea?

    • WhiteCoat says:

      Antibiotics don’t work against sinus infections – if there is truly a sinus infection present. Many times sinus congestion is diagnosed as a sinus infection when no infection is present.

      It is a vicious cycle. Patients want antibiotics. Doctors give antibiotics because they don’t want to make patients upset and get bad Press Ganey scores. Patients then reinforced in the idea that antibiotics cure everything and demand more antibiotics.

      The whole system needs to change.

  3. [...] Closing:┬ábut they’re organic┬áblobs of sugar and wax!; Microbial Armageddon; be one of the lucky 10000 outside, please; more job killing in the name of free trade; warmest [...]

  4. [...] on “Microbial Armageddon” from WhiteCoat’s Call [...]

  5. DefendUSA says:

    MRSA or Antibiotic resistant TB for example–Years ago a tech I worked with said we better be careful about how we use the drugs…and it seems, sadly that his idea had more weight than not. The Army taught us well, but it’s a scary thing to see.

  6. Dan says:

    I’m with Daddy Bear — I actively push back when a doc wants me on antibiotics.

  7. ArkieRN says:

    I recently changed primary doctors because my old doctor kept wanting to over medicate me. Of course, I’m the type of person who treats a UTI with tylenol for pain and tincture of time.

  8. I have an average of 5 arguments with people wanting unnecessary Abx for URI’s every week – and that is just with my staff.

  9. William says:

    Between the ABX and the alcohol hand wash it’s only a matter of time before the superbugs we’re building start showing themselves. Then it will be just like old times.

    William sends.

  10. Nurse k says:

    I’ve never taken an antibiotic for anything related to a URI. And I haven’t died!

    I am wondering, however, about the cost/benefit analysis with antibiotics for pneumonia. If someone is elderly and hypoxic or clearly short of breath, shouldn’t you give the IV levaquin and hope for the best?

    Generally speaking, it’s relatively rare to get a diagnosis of pneumonia in anyone, including young people, when compared to other URIs or related things that can cause the same symptoms…If you ONLY gave antibiotics for pneumonia, whether or not it’s viral (because you can’t tell etc.), wouldn’t that be ideal?

    • WhiteCoat says:

      I agree that there are some patients who benefit from early antibiotic administration. For example, those with sepsis syndrome or those with a high PORT score.
      We’ll never be able to judge with 100% sensitivity and specificity whether or not true pneumonias are bacterial or viral. Governmental coercion to give antibiotics for all pneumonias rather than risk stratifying patients is not only costing us all millions of extra health care dollars in unnecessary antibiotic costs, but it is also causing an epidemic of resistant organisms.

      How many dozens of times each week are we forced to give antibiotics within 6 hours for the smiling healthy afebrile non-coughing patient being admitted for an unrelated complaint because a radiologist sees a “possible pneumonia” or because there is some faint infiltrate on an x-ray that is gone the next day?

      Have the quality indicators even been proven to reduce morbidity or mortality? If so, I haven’t seen any studies proving so.

  11. GTE says:

    So your saying the fact that the higher-ups where I work encourage to just give antibiotics instead of doing a rapid-strep test is bad? But wait, its ok if its improving press-ganey, right?

  12. Grad Student says:

    And here I’ve always used the tried and true that for a sinus infection when the boogers are yellow or green, it’s time for the antibotic. Until then you just wait it out. UTI, cranberry juice and time. :)

    • Marni says:

      No. That’s just the color of boogers. They are supposed to be yellow and green. That doesn’t mean it’s time for an antibiotic.

  13. SeaSpray says:

    What about antibiotic use for people that have joint replacements?

    If exposed to an infection in body, would have to take for 2 years after that. And person would betaking as a precaution, not because ill.

  14. DensityDuck says:

    It’s easier to just give the sheep their magic beans than it is to listen to them bleat about how they drove all this way to see you on their day off and now you’re not even gonna do anything.

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