Unnecessary Overuse of Antibiotics

[Shane]

Two days ago I went to a local health clinic because of a persistent sore throat. Without even doing any tests, a physician's assistant tried to prescribe me antibiotics, "just in case it might be strep." I told the woman that I would gladly take penicillin if I tested positive for strep, but that I didn't want to take antibiotics, "just in case." The PA admitted that I didn't have any of the symptoms of strep throat (no fever, no white spots, no enlarged glands). She said it was, "probably just an irritation in my throat that would eventually get better on its own." But she still recommended that I take antibiotics "just in case."

The physician's assistant told me that the in-office quick test for strep throat wasn't 100% accurate. She said that a negative result on the quick test could sometimes be wrong and that the only way to know for sure if I had strep throat would be to send the sample to a lab and wait 48 hours. I clearly told her that I would be fine with waiting for 48 hours to hear back from the lab. If the results came back positive, I would take the antibiotic she had prescribed for me. If not, I would not take an antibiotic.

Only because I insisted, the PA agreed to have a nurse administer a test for strep throat. The PA left the room and a nurse came in, swabbed the back of my throat and then stood there next to me in the room waiting for the results of the test. The nurse told me that it looked to her like the results of the test were negative, but she said that sometimes the test strips were kind of hard to read. She even showed me the test strip and we took a photo of it with my phone and blew up the photo so that we could see it close up, and it looked to me and the nurse like it was obviously a negative result. The nurse left the room, and a few moments later the physician's assistant returned smiling. Obviously the nurse hadn't mentioned to the PA that she had showed me the results of the test. The PA looked right at me and said, "Well, you tested positive for strep, so I'm going to prescribe penicillin. Please make sure you follow the instructions on the bottle and take all of the pills." I just smiled and said, "Okay, thanks," and left the office. I didn't want to argue with the lady. Afterwards, though, the fact that the physicians' assistant lied to me really started to bother me.

This is the second time in a year that a doctor/PA has attempted to prescribe antibiotics for me to treat a sore throat "just in case" it might be strep. Last summer I needed to get a doctor's note so I could take off work because I had a bad cold, so I went to a local emergency clinic and experienced exactly the same treatment as I did at a different clinic two days ago. In the case last summer, the doctor ordered a quick test for strep, it turned up negative, but he said, "since the in-office test for strep isn't completely accurate and sometimes turns out false negative results, I'm going to prescribe an antibiotic for you anyway." WTF?

My impression is that medical professionals in the U.S. appear to believe that there are no costs associated with prescribing antibiotics, both for individual patients and for society as a whole, and I completely disagree. Personally, I want to reserve antibiotics for cases where I really need them. When I really need antibiotics I want them to work. I believe that physicians' over prescribing of antibiotics is causing them to become less effective, and I think it's extremely irresponsible.

A couple of years ago, my then 5 year old daughter got a really bad and painful infection in one of her lymph nodes. Doctors weren't sure where the infection had come from, but they thought it might have entered her body through an open cut on her foot. Over the course of the next month our pediatrician prescribed a total of 3 progressively stronger antibiotics, none of which had any effect on my daughter's infection. Finally, we had to have a surgeon cut open my daughter's lymph node, drain it and flush it out with an antibiotic solution. It really sucked, and the experience made me more adamant that I don't want to take antibiotics unless I really need them, because I want them to be effective when I or one of my family members need them.

Has anyone else had the experience that doctors seem to just dole out antibiotics like candy, not to treat a specific, identifiable infection, but "just in case" there might be an infection? Am I being overly cautious about antibiotics? I'm curious what others' experiences have been with medical professionals and whether what I've experienced is the norm or if maybe it's just doctors in my area that seem to believe it's okay to prescribe antibiotics to any one who walks in the door with a sore throat?

[bobechs]

Maybe if you were lucky they were just going to pass off a placebo on you.

You seem like you might be the kind of person who could benefit from a placebo or two.

[MOD NOTE: C'mon, now.  We know better than to behave like this]

[Kris]

I haven't had this happen as much, possibly because I tend to be fairly healthy. That said, yes, overuse of antibiotics is a problem, and doctor friends have told me that in many cases, it's because patients expect to get a prescription when they go to the doctor, and ask for antibiotics even for things like the common cold, which is not treatable with antibiotics. Patients report less satisfaction with doctors when they are told to just go home and wait something out.

That said, I think a far worse problem is the widespread use of antibiotics to speed growth in animals used for meat. 

http://www.usnews.com/news/articles/2015/11/16/pediatricians-warn-of-antibiotic-danger-in-meat

[La Bibliotecaria Feroz]

Maybe if you were lucky they were just going to pass off a placebo on you.

You seem like you might be the kind of person who could benefit from a placebo or two.

(a) Prescribing a placebo and telling you it was antibiotics sounds like terrible medical ethics.

(b) I do not understand why you're insulting the OP for questioning terrible medical advice. Isn't rejecting common but bad advice kind of the point of this forum?

My understanding is that overuse of antibiotics in factory-farmed food animals is a much bigger problem than overprescription to humans. Besides rejecting unwise prescriptions, if you're really concerned about this problem, go antibiotic-free.

[Abe]

Antibiotic prescriptions are actually significantly down trending in the US over the last several years due to increased awareness of over-use. For every anecdotal experience of a patient getting unnecessary antibiotics there are some regarding patients (or more commonly, their parents) getting upset that antibiotics aren't prescribed. Regardless, the OP's impression is not borne out by the data. Physicians are well aware of the costs of antibiotic over-prescription. The media has been talking about the coming plague of multi-drug resistant bacteria, but these again has not spread as fast as initially feared. This is mostly due to much stricter control of antibiotic use in hospitals rather than outpatient antibiotics, primarily because the more virulent strains land people in the hospital with severe illness. My main concern is the rampant antibiotic abuse in developing countries, where strong prescription-only antibiotics in the US are readily available over the counter.

That being said, I can't figure out the PA's decision making process. That's really quite bizarre, especially for an otherwise healthy person.

[scottish]

I think the big antibiotic problem in the US comes from feeding it to your food animals to make them grow faster.   

In 2011, 3.29 Million KG of antibiotics sold for use in peeps.
In 2013, 14.8 Million kg of antibiotics sold for use in animal feed.

Sources:
http://www.fda.gov/downloads/drugs/drugsafety/informationbydrugclass/ucm319435.pdf
http://www.fda.gov/downloads/ForIndustry/UserFees/AnimalDrugUserFeeActADUFA/UCM440584.pdf

go Murica!

[Shane]

Maybe if you were lucky they were just going to pass off a placebo on you.

You seem like you might be the kind of person who could benefit from a placebo or two.

[MOD NOTE: C'mon, now.  We know better than to behave like this]

LOL!

Unless the local pharmacist was in on it too, I'm pretty sure the PA had no way of giving me a placebo. :)

[Shane]

I agree with everyone who said that feeding antibiotics to livestock in CAFOs to promote faster growth is a huge problem that also needs to be addressed. It's crazy that that's legal in the U.S. In my case, though, since my family and I raise almost all of our own meat without antibiotics, I'm pretty sure that taking 1500mg of penicillin every day for 10 days straight to treat an imaginary strep throat would be more of a concern for me, personally.

Consumers have a choice, and right now most people are choosing to support the existing factory farming paradigm. People who want meat raised without antibiotics can either hunt wild game, raise their own livestock or support farmers who don't use antibiotics. The problem is, most people aren't willing to pay even a dollar or two more per pound to get healthy meat. They bitch and complain about factory farms, but they're not willing to put their money where there mouths are.

Corporate farms in the U.S. can legally pump their animals full of all kinds of chemicals. The only way we're going to get them to change is to vote with our $$. Just say no to factory farmed meat!

[Shane]

I would at a minimum complain to the practice manager.  The fact that the PA lied to you is inexcusable.

I agree it's bullshit that she lied, but I don't see that there's much to be gained by reporting it to the manager. In ~2 months we're going to take off traveling around the world, so I'll probably never go back to that clinic again. Hopefully, while we're in China none of us will get sick. I wouldn't be too thrilled about the antibiotic IV thing you mentioned. That sounds like something I'd rather avoid. :)

[josstache]

It isn't just a societal problem either -- antibiotics can make the person who took them unhealthier. In my opinion, it is definitely best to take them only when you think you have a bacterial infection.  I wouldn't take them "just in case", unless I had a serious problem that doctors couldn't figure out.  Cold symptoms don't cut it.

http://www.theatlantic.com/health/archive/2015/12/obesity-antibiotics-microbiome/421344/

[Shane]

@Josstache, thanks for the link to the Atlantic article. It was good, but scary.

[AliEli]

Until about 2013, the hospital group I work for had no workable policy on antibiotic use.  Thankfully that has changed, but cultural shift is still taking time.  A lot of people don't understand the problems associated with unnecessary administration of antibiotics, and a lot of health staff feel better appearing to do "something" than sitting back and waiting.  A lot of people seeking healthcare also misunderstand antibiotic use and purpose, and expect to be administered antibiotics whenever they attend hospital.  Oh, and are then surprised that they can't have a single room... bc it's being used for patients who are isolated for, guess what?, antibiotic-resistant infections.  That they picked up in hospital!  Gargh...

[EnjoyIt]

Antibiotic use is rampant in this country and overused for 3 reasons:

1)  Most patients expect and demand it. 
2)  Since medicare has some reimbursement tied to patient satisfaction, providers cater to some of the retarded demands of the patient
3)  Litiagation.  Although a stupid reason, people fear litigation and think buy giving you antibiotics the chance of something bad happening is lower and they are less likely to get sued.

My reasons above don't make them correct, it is just the reasons we have.

On another note, even if you are positive for strep on a throat culture (not a rapid strep test)  You still may not be infected with strep throat.  For example many people are carriers for the bacteria without the infection.  I am such person and doing a culture on me will always be positive.

On another other note, you do not need to treat most throat infections including ones that are strep related with antibiotics.  They will usually heal just fine on their own.

Disclaimer:  This is not medical advice.  Information posted above is for informational, educational and entertainment purposes only.

[Dollar Slice]

Last summer I needed to get a doctor's note so I could take off work because I had a bad cold, so I went to a local emergency clinic

The real problem is this... you have to use emergency care resources when you have a cold that you know needs no treatment? If you do this again I would tell them up front your boss requires a note for sick days and that's why you're here, not because you think you need treatment. It's a huge waste of health care $$ though :-( Bad workplace policy...

I have had a couple alarming experiences with emergency care services, too. One of them I was having a massive allergic reaction (hives, swelling, asthma) to some unknown substance and the PA needed my help googling what a normal test result should be because she didn't know if my breathing was impaired or not from the test results. I feel like if you can't even google successfully you should not be treating patients. :-/  And another time I went in with a terrible cough that turned out to be asthmatic, but I thought might be bronchitis (because it hit when I had a flu/chest cold type virus). The nurse went on a rant about over-prescribing antibiotics and said "I'll give you some cough syrup." Gave me a prescription for hydrocodone (aka the painkiller in Vicodin) which I realize is a cough suppressant, but holy cow. Serious narcotics, which suppress breathing, to a patient who comes in and says they are having trouble breathing? I went to my regular doctor the next day because knew this was not correct treatment - they correctly diagnosed me and gave me asthma meds and I think they may have reported that nurse to the DEA...

[MMMaybe]

Besides the issues of overuse and antibiotic resistance, using antibiotics is like taking napalm and applying it liberally to the entire immune system/gut microbiome. Its like here, you want to kill this particular bug but I am going to kill everything else, good and bad. Then in the resulting power vacuum, you can allow a Lord of Flies situation to develop, whereby the less desirable bugs can take hold.

If you take time to look at the research on the gut microbiome, where approximately 90% of your immune system resides, you will see how devastating antibiotic use is. Its way better to build up your immune system and let it fight off bugs on its own.

I concentrate on feeding up the good bacteria in my gut and by and large, I don't get sick. I just did a 2 year stint in the Philippines without incident so...it works :)

If anyone is interested, I will post a short video by a gastroenterologist where she explains this way better than I can.

[former player]

Presumably if giving antibiotics to healthy animals helps them put on weight then giving antibiotics to healthy humans also helps them to put on weight.

Yay, another explanation for the obesity crisis.

[Carless]

Presumably if giving antibiotics to healthy animals helps them put on weight then giving antibiotics to healthy humans also helps them to put on weight.

Yay, another explanation for the obesity crisis.

Advertising that would probably very effectively cut down on over use.  'Sure you can have these, but they'll make you fat...'

[golden1]

I have found that doctors around here are less likely to give antibiotics than they used to 10 years ago. 

A lot of the problem is patients that want to go to a Doctor and feel better right away, plus our workplace culture that doesn't give people time to get better by resting.  I actually hate taking antibiotics because they screw up my digestion for weeks or months afterwards. 

[Tom Bri]

Strep is usually self-limiting, but it can cause some really serious cardiac problems, so docs may want to err on the side of caution.

That doesn't excuse lying, which is malpractice.

[marty998]

I try and avoid antibiotics because of what it does to your bowel movements! Do not enjoy it one bit...

It should be stressed that antibiotics do not kill viruses, they only kill bacterial infections. Since most strains of the flu are viruses, I really don't know why it is being prescribed.

My little rant though...honestly, by the time you start coughing and have a runny nose you've already infected everyone around you and your body is already getting over it. It's too late to start treatment*, just let your white cells kill the rest of it off and build immunity for the next time.

* I only advocate the eat concrete and harden up treatment for otherwise healthy adults. If you have babies or are elderly, obviously do the right thing and get the proper cough medicine.

[Shane]

Last summer I needed to get a doctor's note so I could take off work because I had a bad cold, so I went to a local emergency clinic

The real problem is this... you have to use emergency care resources when you have a cold that you know needs no treatment? If you do this again I would tell them up front your boss requires a note for sick days and that's why you're here, not because you think you need treatment. It's a huge waste of health care $$ though :-( Bad workplace policy...

I totally agree. On the day mentioned in my example my boss was there and saw how sick I was. He was the one who told me, "You're really sick. You should go home. Oh, and by the way, don't forget to stop at Urgent Care to get a doctor's note for your absence." WTF? Everyone who was at work that day, including my supervisor, could see that I was obviously really sick, but yet I still needed a note from a doctor saying that I was sick. It makes absolutely no sense.

When I checked in at Urgent Care I clearly told the receptionist that the reason I was there was to get a sick note to give to my employer. After I had filled out their questionnaire, before I had even been seen by a doctor, the receptionist asked me, "Which pharmacy will you be using today?" To which I answered, "That's okay. I don't need any pills. I've just got a cold and I want to go home and rest, but I need a doctor's note to give to my employer so they'll let me take sick leave." The receptionist was like, "Well, just in case the doctor prescribes something for you, which pharmacy would you like us to send the prescription to?" I laughed and said, "If the doctor wants to prescribe something for me, that's up to him, but I won't be picking up the prescription, so you can send it to any pharmacy you like." :) When the doctor came into the examination room he asked, "So, what can I do for you today?" The first words out of my mouth were, "I need a note that says I'm sick so that my employer will allow me to use sick leave." And he still insisted on prescribing an antibiotic for me, "just in case" I might have strep throat.

[MayDay]

Abe, I am glad to hear that overall antibiotic use is declining.  Sadly, In haven't seen it firsthand. 

I read an interesting study that said ABX scripts went up the more tired a doc is (towards the end of their shift).  They get sick of trying to convince patients they don't really need ABX, and just give in to get them out the door.  Not surprising. 

A similar study found that when practices had specific ABX guidelines and the docs had to click through them in the EMR system, scripts went way down. 

Now, anecdote time!

We have HDHP insurance, so every visit costs me a couple hundred bucks and an annoying 2 hours wasted.  The kids had a pediatrician who never listened to me (we have since switched).  DD had a bad splinter with what I thought was red streaking.  He didn't notice the streaking, I had to shout him back into the room as he fled it after a quick look at the splinter.  Are those streaks?  I asked.  "Yes, here's a script for ABX".  WAIT!  I say.  Are they bad?  Does she really need the script right now?  Can I just hold onto it and fill it in a day or so if the streaks don't go away?  "Yes that's fine, they aren't bad at all". 

Then why the F did you shove the script at me?  Why didn't you tell me that it was ok, and say she doesn't really need ABX?  I am sure he was used to parents wanting them, and assumed that is what I wanted, and just wanted me to move along and not bother him.  I actually DIDN'T want them, but I sure as heck didn't want to have to haul back in tomorrow if it got worse. 

UGH.  Shockingly, the streaks went away by the next day and we never filled the script.

[Inaya]

TLDR: I have the opposite problem and can't get them when I need them.

I am very susceptible to the streptococcus illnesses. As a child, I felt like it was all antibiotics all the time for ear infections and strep. Nowadays I try to avoid antibiotics wherever possible. However, I'm still prone to streptococcus. It usually manifests as impetigo. But once in a while it'll decide to be strep throat, at which point I usually go for the antibiotics because strep can have some pretty nasty complications that I am at risk of because I'm so prone to the disease to begin with.

My strep cases are textbook: fuzzy white splotches on tonsils, high fever, unable to swallow/talk, lack of respiratory symptoms. And since I've had strep so much, I KNOW strep when I see it. Yet for some stupid reason, my rapid results come up negative. And they won't give me antibiotics without the stupid culture coming up positive (and they ALWAYS do)! Even though I have a history of strep and risk factors for complications!  And I feel like asking them to give me the antibiotics without a positive culture makes me sound like one of those people who demands antibiotics for everything and will only make my case worse.

On one hand, I'm glad the US is backing away from giving antibiotics out like candy--on the other, I'm not thrilled to be denied what could ultimately, due to my risk factors, be a lifesaving treatment.

[Bellatrix]

You are very atypical. Most of my patients demand antibiotics even after I explain that they most likely have a virus and that antibiotics won't help. I hate that Urgent Care Centers tend to give everyone antibiotics.   

I'm surprised the PA lied to you though. That is so wrong. 

[Luke Warm]

funny that this post came up. i just found a tick on me now i'm back on doxycycline for a few weeks. dang it.

[I'm a red panda]

You are very atypical. Most of my patients demand antibiotics even after I explain that they most likely have a virus and that antibiotics won't help. I hate that Urgent Care Centers tend to give everyone antibiotics.   

I'm surprised the PA lied to you though. That is so wrong.

My husband and I both had a condition last year that we went for urgent care for.  They gave me antibiotics "just in case" (because I was pregnant- and it could get very bad if left untreated), but told him he had to wait.

Since my husband's PhD was research about antibiotic resistance, he was very pleased with this.  Though it sure sucked to wait, since it turns out, we both needed them.

[stlbrah]

I find antibiotic use to be reckless.

I went in for Traveler's Diarrhea and was given a heavy dose of Cipro.

I took it and then td cleared up over night. Not too long after that i saw a post on a bodybuilding callsed "Do not take Cipro. Why it ruined my life" or something similar and there were a lot of replies.

Sure enough, shortly after that I got patellar tendinitis. I have had it for almost a year now, it is getting better, but I haven't been able to do a heavy squat or most leg exercises since last summer.

While I can't guarantee the cipro caused it, my GP said the doctor should have recommended to lay off any heavy training for a while if I took it, and should have just recommended a BRAT diet and immodium until it cleared. He said he has seen tons of cases with tendon damage from cipro. It is a serious drug that is treated like tylenol by some doctors


Not exactly related to the original post but I thought I'd share.

[dougules]

Yes, I completely agree.  I would find another doctor and get a second opinion.  Antibiotics have some huge risks that nobody seems to acknowledge.  I had a neurological reaction to an antibiotic 10 years ago, and I'm still having a few issues from it. 

On top of that, there's some new evidence that good bacteria in your gut could be doing a whole lot for your body including keeping you thin, keeping you from being depressed, and keeping your immune system on track.  There are even some theories now that autism may be caused by issues with the good bacteria in your gut.  Antibiotics wipe out those good bacteria. 

Then there's the whole issue around overuse of antibiotics creating drug-resistant bacteria. 

Don't get me wrong.  Antibiotics are a life saver in the right circumstance, but they are not candy. 

[paddedhat]

I find antibiotic use to be reckless.

I went in for Traveler's Diarrhea and was given a heavy dose of Cipro.

I took it and then td cleared up over night. Not too long after that i saw a post on a bodybuilding callsed "Do not take Cipro. Why it ruined my life" or something similar and there were a lot of replies.

Sure enough, shortly after that I got patellar tendinitis. I have had it for almost a year now, it is getting better, but I haven't been able to do a heavy squat or most leg exercises since last summer.

While I can't guarantee the cipro caused it, my GP said the doctor should have recommended to lay off any heavy training for a while if I took it, and should have just recommended a BRAT diet and immodium until it cleared. He said he has seen tons of cases with tendon damage from cipro. It is a serious drug that is treated like tylenol by some doctors


Not exactly related to the original post but I thought I'd share.

Cipro can be really evil stuff. My wife has a seizure disorder from a brain injury. We have memorized a short list of drugs that she can never be given, and Cipro is one. Unfortunately, she found out the hard way that Cipro will cause seizures in a person with a brain injury. Not only was this a result of an incompetent doctor, I have actually been in another Dr's face, as I was aggressively explaining to him that he was not going to give her Tramadol. A drug with a statistically significant chance of causing severe seizures in brain injured patients. The Dr. in question was a highly paid pain specialist, and wanted to argue about something he didn't have a clue about. As a laymen, I had actually read the PDR info. on this drug, after the wife's neurologist told her that it was one of the drugs she should be quite sure to never take. Even with this info. given to specialist, she later has seizures due to being prescribed a tramadol derivative, that ( not surprisingly) the Dr. had no idea was in the Tramadol family.

When it comes to overprescribing antibiotics, I actually diagnosed and cured a issue I was suffering from, based on a comment found on this forum. My immune system is pretty compromised, and as a result, I deal with lots of allergy and Asthma issues. Last summer I spent the whole time battling an ear "infection" that blocked the Eustachian tubes with inflammation. I saw two different docs. who both prescribed useless antibiotics. I eat just about zero dairy, but I had gotten into the habit of eating a few small Greek yogurts, every week. I was reading a MMM thread about DIY yogurt making, when somebody commented that they can't touch yogurt without getting "ear infections".  A bit more research revealed that it's an obscure allergic reaction, that is obviously not well known, or acknowledged by standard western medicine.  I stopped dairy completely and the ears healed.

[I'm a red panda]

my GP said the doctor should have recommended to lay off any heavy training for a while if I took it

OMG yes they should have. Tendon and ligament damage and rupture is like the most common side effect of cipro.

I find that pharmacists can be really lax about "counseling" the people who get medicine; they are all so rushed.  (I once had a pharmacist call me the day after getting a prescription to tell me they forgot to mention that it would make me extremely sun sensitive. Since I already had skin peeling water blisters from a severe sunburn, I had figured that out...)

[Inaya]

Correct me if I'm wrong here, but isn't all that information provided in that pile of fine print they give you along with the medication? Don't get me wrong--the pharmacist should absolutely be giving you this information. But shouldn't everyone educate themselves about what they're putting into their bodies?

[Dollar Slice]

Correct me if I'm wrong here, but isn't all that information provided in that pile of fine print they give you along with the medication? Don't get me wrong--the pharmacist should absolutely be giving you this information. But shouldn't everyone educate themselves about what they're putting into their bodies?

I'm one of those lucky people who often gets the rare/oddball side effects from drugs, so I always skim through that info just in case there is anything dangerous. I can't tell you how many people have told me not to because "you'll just start imagining that you have them all" if you read them. So I guess a lot of people don't read that info, and everyone I know is a self-diagnosed hypochondriac.

[I'm a red panda]

Correct me if I'm wrong here, but isn't all that information provided in that pile of fine print they give you along with the medication? Don't get me wrong--the pharmacist should absolutely be giving you this information. But shouldn't everyone educate themselves about what they're putting into their bodies?

At least at my pharmacy, I don't always get that.  I didn't when I took whatever that thing was that caused my skin to boil (15 years ago...)- the pharmacist just went through a list of interactions and told me my birth control would be ineffective.

But I live with a medicinal chemist, so I always get a long spiel about whatever I'm taking. Sometimes he even diagrams it for me...

[dougules]

Correct me if I'm wrong here, but isn't all that information provided in that pile of fine print they give you along with the medication? Don't get me wrong--the pharmacist should absolutely be giving you this information. But shouldn't everyone educate themselves about what they're putting into their bodies?

Yes, definitely, you should ask probing questions to the doctor about every aspect of any prescription, especially side effects and risks.  Then you should read everything you can before taking the first pill unless it is a burning emergency.  The doctor may be the expert, but it's your body and your choice. 

Another thing is that a lot of the issues are in the fine print for older drugs, but if it's newer you get to be the guinea pig.  Ask the doctor how long it's been out, and if it's something new and shiny, ask if there's not something older and more proven that will do just as well.  Drug salesmen are hitting doctors' offices constantly peddling the latest and greatest new drug.  (You'll also have the added benefit of getting cheaper generic drugs if something older will do the same job). 

[acroy]

eat concrete and harden up treatment

I LOL'd. hahaha!

[big_owl]

You all sound like a bunch of antibiotics wussies.  I've been on them for 8 months straight.  Azithromycin, Doxycycline, Cipro (6wks), Levofloxacin (6wks), Moxifloxacin (3mo!!)...nothing bad has happened to me!!!

Joking aside, I HATE it.  Side effects have ranged from acne to IBS to, sore joints, and feeling 120 years old (levo was the worst).  Not to mention the $300/mo they cost!  I still do all my bodybuilding without problems so I must not be prone to the tendon ruptures that quinolones (cipro/levo/moxi) are known for.  The Moxi seems to give fewer side effects though it is stronger than cipro.

In my case, I've ruined my last year of life because my general practitioner didn't want to prescribe me antibiotics early on.  I could have been done in a few weeks but she refused.  Infection spread before treatment started....here I am almost a year later with no end in sight.  Let's be careful not to jump on the no-antibiotics bandwagon full tilt.

[Dollar Slice]

You all sound like a bunch of antibiotics wussies.  I've been on them for 8 months straight. 

I was on them for an entire year when I was four. Good times. :-(

I'm half convinced that my pathetic immune system is a direct result of that year. (Currently getting over my third nasty head cold in six weeks.)

[Inaya]

Let's be careful not to jump on the no-antibiotics bandwagon full tilt.

I don't think anyone in this thread is anti-antibiotics. Most people seem to be against the prescribing of antibiotics for stubbed toes, allergies, and viruses. The poster who talked about 4 days of IV antibiotics just so the doctors can make money is a prime example. I didn't get the impression that anyone was against antibiotics when genuinely needed.

[big_owl]

Let's be careful not to jump on the no-antibiotics bandwagon full tilt.

I don't think anyone in this thread is anti-antibiotics. Most people seem to be against the prescribing of antibiotics for stubbed toes, allergies, and viruses. The poster who talked about 4 days of IV antibiotics just so the doctors can make money is a prime example. I didn't get the impression that anyone was against antibiotics when genuinely needed.

Relax, I wasn't accusing anybody.  It was just a generic statement that sometimes being too sintgy on the antibiotics can have extremely bad consequences as well.

[justajane]

I took a Cipro-like drug - Levaquin. I wouldn't take that stuff again unless I was dying. It was MISERABLE. In the doctor's defense, they thought I might have had sepsis, so it was warranted to give me a super-large IV dose of the stuff while in the hospital. But I had no idea about the side effects. I had to stay on it for another week, and I couldn't sleep at all. Plus my muscles started to hurt, especially my neck.

When I had a follow-up with the ENT for what ended up being the world's worst double ear infection in one ear, the ENT pointed to my Achilles Tendon and said, "If you feel pain there, stop taking Levaquin ASAP." Apparently it is known to rip it, even months after going off the drug! And yes, people get lifelong tendonitis and other problems after Levaquin. Come to think of it, I have a chronic hip pain/iliopsoas pain on one side two years later. There would be no way to prove it was from the Levaquin, but I wouldn't be surprised.

So for me, it's less about not taking antibiotics and more about staying away from the newer antibiotics unless you absolutely need them.

The safest is obviously penicillin. If you think you're allergic, you're probably not. At least that's what the allergist told me when I spent 4 hours getting tested to verify that I was indeed not allergic. The pediatrician declared me allergic after I had a childhood rash. The allergist said approximately 80% of people who think they are allergic to penicillin-class drugs aren't. But you have to get this pretty expensive and long test to verify, and most people aren't willing to do it.

This relates to the current problem, because so many people have to take these more complex and newer antibiotics because they think they are allergic to penicillin.

[big_owl]

I took a Cipro-like drug - Levaquin. I wouldn't take that stuff again unless I was dying. It was MISERABLE. In the doctor's defense, they thought I might have had sepsis, so it was warranted to give me a super-large IV dose of the stuff while in the hospital. But I had no idea about the side effects. I had to stay on it for another week, and I couldn't sleep at all. Plus my muscles started to hurt, especially my neck.

When I had a follow-up with the ENT for what ended up being the world's worst double ear infection in one ear, the ENT pointed to my Achilles Tendon and said, "If you feel pain there, stop taking Levaquin ASAP." Apparently it is known to rip it, even months after going off the drug! And yes, people get lifelong tendonitis and other problems after Levaquin. Come to think of it, I have a chronic hip pain/iliopsoas pain on one side two years later. There would be no way to prove it was from the Levaquin, but I wouldn't be surprised.

So for me, it's less about not taking antibiotics and more about staying away from the newer antibiotics unless you absolutely need them.

The safest is obviously penicillin. If you think you're allergic, you're probably not. At least that's what the allergist told me when I spent 4 hours getting tested to verify that I was indeed not allergic. The pediatrician declared me allergic after I had a childhood rash. The allergist said approximately 80% of people who think they are allergic to penicillin-class drugs aren't. But you have to get this pretty expensive and long test to verify, and most people aren't willing to do it.

This relates to the current problem, because so many people have to take these more complex and newer antibiotics because they think they are allergic to penicillin.

Levaquin!!!  Ack!!!  Levaquin = Levofloxacin, that's one I was on for six weeks.  Sides about the same for me.  About 3 weeks into it I literally felt like I was some arthritis-ridden centurion.  Joints, muscles...even getting out of my desk chair at work was a chore.  Everyone used to joke that I was some crippled bodybuilder since they didn't know the real reason behind my condition.  Eventually I decided I couldn't handle it anymore so recommended Avalox (moxifloxacin) to my doc.  About as strong as Levaquin but luckily the only sides have been digestive related and some acne.  Quinolones are supposedly known to erode joint cartilage as well.  Unfortunately for certain infections they're the only game in town.  I hope to get off them someday.

[goatmom]

funny that this post came up. i just found a tick on me now i'm back on doxycycline for a few weeks. dang it.

If I took antibiotics every time I found a tick on me, I would always be on antibiotics!

[big_owl]

funny that this post came up. i just found a tick on me now i'm back on doxycycline for a few weeks. dang it.

If I took antibiotics every time I found a tick on me, I would always be on antibiotics!

Haha while diagnosing my other raging infection they also found I had lymes disease!  Oops...there went a month on doxycycline.  Doxy has minimal side effects and is pretty bland so that was pretty easy compared to the others. 

[Abe]

Fluoroquinolones do have more side effects than penicillin-based antibiotics (beta-lactams), and are really only second-line therapy for either penicillin-resistant bacteria or for severe infections. They aren't warranted for nearly all infections treated as an outpatient. So in summary, if you weren't recently hospitalized for _, you shouldn't be treated with a fluoroquinolone unless you have a documented, true allergic reaction to penicillin derivatives.

[warmastoast]

I wouldn't allow a PA to treat me.  Nurse practitioner ok.  Doctor preferably.  I'd rather have someone looking at me with all the training needed to spot anything else that might be going on. 

In dentistry we have ongoing battles with cardiologists regarding the routine use of anti-biotics for "at risk" cardio patients when having dental treatment.  The abx are not needed (research backs this up) but the odd ones still try to insist.

[shelivesthedream]

I wouldn't allow a PA to treat me.  Nurse practitioner ok.  Doctor preferably.  I'd rather have someone looking at me with all the training needed to spot anything else that might be going on. 

In dentistry we have ongoing battles with cardiologists regarding the routine use of anti-biotics for "at risk" cardio patients when having dental treatment.  The abx are not needed (research backs this up) but the odd ones still try to insist.

I really don't want to be getting all anecdotal on this shit, but a friend of mine's husband died a year ago because an infection after routine dental treatment spread to his heart and he had a congenital heart defect that meant that he should have been given precautionary antibiotics by the dentist (but for some reason he wasn't). The antibiotics message is that all we healthy people should NOT be asking for routine antibiotics so that when people like my friend's husband take them, they still work for everyone.

[sheepstache]

On another note, even if you are positive for strep on a throat culture (not a rapid strep test)  You still may not be infected with strep throat.  For example many people are carriers for the bacteria without the infection.  I am such person and doing a culture on me will always be positive.

But...aren't you still "infected" if you're a carrier?  You're just asymptomatic. And wouldn't the antibiotics still clear it from your system? And couldn't you give it to other people if you're a carrier?  No medical background here, genuinely curious.

Disclosure: I get annoyed at people who are diagnosed with strep and then show up back to work less than 24 hours after starting antibiotics because I was super susceptible to it for a couple years after having picked up a nasty strain without realizing it and developed rheumatic fever.

Advertising that would probably very effectively cut down on over use.  'Sure you can have these, but they'll make you fat...'

That's brilliant.

[big_owl]

Fluoroquinolones do have more side effects than penicillin-based antibiotics (beta-lactams), and are really only second-line therapy for either penicillin-resistant bacteria or for severe infections. They aren't warranted for nearly all infections treated as an outpatient. So in summary, if you weren't recently hospitalized for _, you shouldn't be treated with a fluoroquinolone unless you have a documented, true allergic reaction to penicillin derivatives.

Hmm, someone needs to tell that to the specialists and just about every piece of literature on the type of infection I'm currently dealing with (and I've read dozens of them).  Fluoroquinolones are the defacto treatment option.  Don't get me wrong, I wish it weren't so.

[Drifterrider]

In the US most medical personnel take the "better safe than sued" position. 

[big_owl]

I wasn't going to post in this thread again, but since I've been doing a lot of research on this topic over the past week or so I figured I'd follow-up.  Naturally since I've been on FQs for about 6mo I'm concerned about side effects.

All this talk about tendon rupture had me do some research on the facts.  From what I can find, it turns out the actual data isn't as scary as the rhetoric.  Actual data supports rupture rates (a term I've since learned as Tendinopathy) in the range of 5-20 per 100,000.  Supposedly normal rates are in the range of 1-2 per 100,000.  So yes, there is an elevated risk, but it's still pretty low.  Just pulling this outta my ass, but using FQs still seems safer than biking to work...

Other info I've been able to find on the subject indicates that age definitely has something to do with it...older people being relatively more susceptible.  Most occurrences are for ages 60+. 

Another interesting tidbit, in those who experience ruptures, almost all occur within the first month of treatment with most actually happening in one to two weeks.  It would appear that if you can make it several weeks without incident then you're unlikely to experience a rupture. 

Most of the other side effects like digestion problems and neurological problems are reversible when treatment is completed.

Anyway, not a doctor...just an engineer.  But it's good to know that things aren't quite a precarious as some of the hyperbole.