7 ms·

Medical professions risk losing a patient or being sued if hey misdiagnose a condition, so the understandable reaction is to throw antibiotics at the problem ra

by uptown 10y ago

Medical professions risk losing a patient or being sued if hey misdiagnose a condition, so the understandable reaction is to throw antibiotics at the problem rather than waiting for test results to come-back to determine whether a specific course of care is appropriate. The good news is that some test times are decreasing dramatically ... from days to minutes in many cases: http://nanologix.com/test_results.html http://nanologix.com/test_results.html * tuberculosis from 21+ days to 1.5 hours. * e.coli from 18 - 24 hours to 30 minutes * salmonella from 24 hours to 30 minutes * group b streptococcus from 48 - 72 hours to under an hour My hope is that faster results leads to fewer unnecessary prescriptions being administered, and better overall care for the patients.

akiselev 10y ago
Are the false positive rates comparable between the older slow tests and the new fast ones?
- Fomite 10y ago
  Depends very much on the test. The study I did for rapid influenza tests showed that their accuracy was pretty bad. Very sensitive, not at all specific.
atmosx 10y ago
> Medical professions risk losing a patient or being sued if hey misdiagnose a condition, so the understandable reaction is to throw antibiotics at the problem rather than waiting for test results to come-back to determine whether a specific course of care is appropriate. As a pharmacist, my experience says otherwise. I think the following are the main reasons for bacterial resistance: a) Patient doesn't respect doctor's/pharmacist's guidelines. He feels much better after day 3, so he stops his class X ATB in day 4 instead of day 7. If bacteria survives, might very well be class X ATB-resistant. b) Patient has a relative who when was feeling sick took ATB XYZ and got better. The main reason for this is poverty: A visit to the doctor might cost 25-120 EUR. c) Hospitals. MRSA became "MR" in hospitals, where bacteria conjugation takes place. That said, at some in point, we should expect bacterial organisms to evolve some kind of resistance. That's how evolution works.
- Retric 10y ago
  This ignores livestock which is both a huge vector for resistance and part of the food chain. It's not like this is new, Sulfa drugs worked really well for a short period of time before penicillin and are now somewhat useful.
  - photoJ 10y ago
    This. FDA estimated 80% of antibiotics are used for livestock. Cite: https://www.govtrack.us/congress/bills/112/hr965/text https://www.govtrack.us/congress/bills/112/hr965/text
- jp555 10y ago
  "That's how evolution works" - good point, and also probably a promising area to look for new ideas. e.g. bacteriophages
  - Florin_Andrei 10y ago
    Fight (blind) evolution with (directed) evolution. In the long run, it's the only strategy that works.
- chrisgd 10y ago
  How much of bacterial resistance is from patient's not finishing a dose of medicine and how much is from increased use of antibiotics as a whole (in the farm system, in people, etc)?
  - photoJ 10y ago
    Researchers are not totally clear on this. One particularly dangers spread is counterfeit medications that don't reach the MIC required to kill the Bacteria, and instead create in people exactly the same situation that biologist use to grown AMR bacteria in the lab.
- iLoch 10y ago
  Regarding (a) - do you know that I've never been told why I need to finish my antibiotics? For some reason (arrogance?) doctors don't explain their reasoning in many cases (I live in Canada FWIW.) If I was told "hey, you need to finish your antibiotics or you'll risk becoming immune to them, potentially putting yourself or your family, colleagues, or friends at risk" I don't think even the dumbest person would ignore that warning. Then they could even explain WHY that is, if the patient was curious. Instead, here in Canada, you say you're sick, the doctor will likely immediately perscribe antibiotics, then shuffle you out the door in less than 5 minutes.
photoJ 10y ago
And faster identification of AMR strains in order to choose first line AB's appropriately.

by uptown 10y ago

akiselev 10y ago

Are the false positive rates comparable between the older slow tests and the new fast ones?

Fomite 10y ago
Depends very much on the test. The study I did for rapid influenza tests showed that their accuracy was pretty bad. Very sensitive, not at all specific.

atmosx 10y ago

> Medical professions risk losing a patient or being sued if hey misdiagnose a condition, so the understandable reaction is to throw antibiotics at the problem rather than waiting for test results to come-back to determine whether a specific course of care is appropriate. As a pharmacist, my experience says otherwise. I think the following are the main reasons for bacterial resistance: a) Patient doesn't respect doctor's/pharmacist's guidelines. He feels much better after day 3, so he stops his class X ATB in day 4 instead of day 7. If bacteria survives, might very well be class X ATB-resistant. b) Patient has a relative who when was feeling sick took ATB XYZ and got better. The main reason for this is poverty: A visit to the doctor might cost 25-120 EUR. c) Hospitals. MRSA became "MR" in hospitals, where bacteria conjugation takes place. That said, at some in point, we should expect bacterial organisms to evolve some kind of resistance. That's how evolution works.

Retric 10y ago
This ignores livestock which is both a huge vector for resistance and part of the food chain. It's not like this is new, Sulfa drugs worked really well for a short period of time before penicillin and are now somewhat useful.
- photoJ 10y ago
  This. FDA estimated 80% of antibiotics are used for livestock. Cite: https://www.govtrack.us/congress/bills/112/hr965/text https://www.govtrack.us/congress/bills/112/hr965/text
jp555 10y ago
"That's how evolution works" - good point, and also probably a promising area to look for new ideas. e.g. bacteriophages
- Florin_Andrei 10y ago
  Fight (blind) evolution with (directed) evolution. In the long run, it's the only strategy that works.
chrisgd 10y ago
How much of bacterial resistance is from patient's not finishing a dose of medicine and how much is from increased use of antibiotics as a whole (in the farm system, in people, etc)?
- photoJ 10y ago
  Researchers are not totally clear on this. One particularly dangers spread is counterfeit medications that don't reach the MIC required to kill the Bacteria, and instead create in people exactly the same situation that biologist use to grown AMR bacteria in the lab.
iLoch 10y ago
Regarding (a) - do you know that I've never been told why I need to finish my antibiotics? For some reason (arrogance?) doctors don't explain their reasoning in many cases (I live in Canada FWIW.) If I was told "hey, you need to finish your antibiotics or you'll risk becoming immune to them, potentially putting yourself or your family, colleagues, or friends at risk" I don't think even the dumbest person would ignore that warning. Then they could even explain WHY that is, if the patient was curious. Instead, here in Canada, you say you're sick, the doctor will likely immediately perscribe antibiotics, then shuffle you out the door in less than 5 minutes.

photoJ 10y ago

And faster identification of AMR strains in order to choose first line AB's appropriately.