Comments on: Microbial Armageddon

By: DensityDuck

DensityDuck — Tue, 15 May 2012 19:57:53 +0000

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.

By: Marni

Marni — Tue, 15 May 2012 12:09:56 +0000

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.

By: SeaSpray

SeaSpray — Mon, 14 May 2012 07:28:50 +0000

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.

By: Grad Student

Grad Student — Sun, 13 May 2012 06:04:10 +0000

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.

By: GTE

GTE — Fri, 11 May 2012 21:54:53 +0000

I agree. But in practice, no criteria are used. Anyone who wants antibiotics, gets them. One of several reasons I will be switching positions.

By: WhiteCoat

WhiteCoat — Fri, 11 May 2012 16:20:37 +0000

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.

By: WhiteCoat

WhiteCoat — Fri, 11 May 2012 16:16:40 +0000

In certain cases, empiric antibiotics for pharyngitis are appropriate. I'd have an issue with being encouraged to give antibiotics to everyone. Perhaps that's one reason why highly satisfied patients are more likely to die than their less satisfied counterparts.

By: WhiteCoat

WhiteCoat — Fri, 11 May 2012 16:13:29 +0000

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.

By: GTE

GTE — Thu, 10 May 2012 23:45:45 +0000

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?

By: Nurse k

Nurse k — Thu, 10 May 2012 19:32:26 +0000

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?