7 ms·

From conversations with medical professionals: Antibiotic “misuse” is one of the most frustrating things in the field. They’re taught about antibiotic resistanc

From conversations with medical professionals: Antibiotic “misuse” is one of the most frustrating things in the field. They’re taught about antibiotic resistance in school, but then contribute to the problem by overprescribing it. The y describe the circumstances that patients (and parents) just want “a pill” to solve “a problem”, and that while the doctors know that it’s a viral infection, they still prescribe the antibiotics to placate the patient/parent. Further compounding the problem. They’d be better just prescribing placebos or “drink some ginger garlic tea and rest”

cortesoft 5y ago
Isn’t this paper actually debunking that argument (That overuse of antibiotics has increased antibiotic resistance)? The paper says that resistance didn’t diminish when antibiotic use was decreased. It seems that our common understanding of how resistance develops was incorrect, at least partially.
- commiefornian 5y ago
  If there is selective pressure to increase resistance, resistance increases over time. If there is not selective pressure to increase resistance... nothing. There is no pressure to change anything relating to resistance. It could increase. It could decrease. It could stay the same. There is no reason to expect anything in particular about it.
fennecfoxen 5y ago
Well, that’s not covered by my health plan!
snarf21 5y ago
Of course, but the US fee-for-service model is aligned elsewhere. I think a lot of them think that as long as they are not prescribing a z-pack every month, it won't be that big of a deal. Also, customer acquisition is hard. Patients will just find another primary or go to an urgent care and get the meds there. For primary care, being seen as "not helpful" won't just lose one patient, but a whole household of them. As you quote above, people want a quick fix. The person consuming 3000 calories of carbs per day wants a magic pill to fix their type 2 diabetes without them having to make any changes. I don't envy them.
- nradov 5y ago
  SGLT2 inhibitors pretty much are magic pills for type 2 diabetes. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/sodium-glucose-cotransporter-2-sglt2-inhibitors https://www.fda.gov/drugs/postmarket-drug-safety-information... But of course it's better to prevent the condition in the first place.
  - tsol 5y ago
    Wait until people find out the side effects, then you'll get another thread exactly like this one but about SGLT2 inhibitors instead of antibiotics
  - orangepurple 5y ago
    Autophagy is the real silver bullet for T2DM treatment but you won't get that from a pill especially if you continue to ingest sugar.
  - snarf21 5y ago
    Another very promising treatment for type 2 is DMR. We need to do a lot more research on the duodenum as it is clear it is a major linchpin in type 2. [https://gut.bmj.com/content/69/2/295 https://gut.bmj.com/content/69/2/295]
avgDev 5y ago
I do not understand why there is a huge gap between scientific knowledge and physicians. I had a problem with an allergic reaction to an antibiotic. This resulted in me actually paying attention to drug labels, side effects and what a drug is being prescribed for. It has quite literally ruined my trust in doctors. Last year I had stomach pain, I thought it was appendix. So, I went to an urgent care because my physician could not see me. They had access to my medical records. Quickly, I receive a diagnosis of "Diverticulitis". 2 minutes later I'm given a prescription for Cipro, which I'm deadly allergic to. New guidelines suggest not using antibiotics in uncomplicated diverticulitis. I didn't take the meds, and I'm pretty sure I just pulled an abdomen muscle as it healed over the next few weeks. I have many stories from sports injuries and doctors offering steroid injections as first line treatment, which is no longer recommended. NSAIDs are also not recommended for tendon injuries and it is the first thing the doctor will offer. I don't get it. The information is easily available. Saying I read a study or a updated recommendation gets most doctors visibly upset. Not sure if it is the long working hours and trying to move as many patients as possible or just lack of giving a fuck.
- bserge 5y ago
  It's both. On the one hand, I hate the fuckers who don't give a shit, I've met way too many of them. On the other hand, too many times they are overworked and/or underpaid. At some point anyone will stop giving a fuck. Surgeons, dentists, EMTs deserve respect though. Yeah they fuck up, but nowhere near as often or bad as those responsible for gatekeeping useful medicine.
- peakaboo 5y ago
  It's about money and they just want to get rid of you, because they are understaffed, overworked and not happy people.
- nradov 5y ago
  I don't have the citation handy but the Institute of Medicine researched this and found it takes about 17 years in average to get all physicians to adopt new clinical practice guidelines. For physicians with a wide scope of practice it's just tough to keep up with all the chances. There might be some opportunities to use technology in clinical decision support systems that warn about potentially inappropriate treatments, but those have to be handled carefully so as to not slow down patient care unnecessarily.
beached_whale 5y ago
There was talk to the placebos on SBM at one point, the gist of it being that it would be far worse for them to do so for a few reasons. It erodes trust is the big point. But, I assume, there would be issues with informed consent too. How does one prescribe a placebo where the user can lookup the drug by name online. Not a medical professional, but I think the issue comes down to doctors saying no as a group and being ok if they shop another doctor. If enough do that, the issue goes away.
cogman10 5y ago
I have to wonder, though, if it's human prescribed antibiotics that source these super-bugs. It's pretty common practice in the cattle industry, for example, to just pump cows with antibiotics because studies have shown cows constantly on antibiotics grow fatter than cows not on antibiotics. (Likely, because they don't ever really get sick). [1] That makes me wonder how many of our super bugs have origins in the livestock industries where common practice is literally a recipe to bread superbugs. [1] https://www.cidrap.umn.edu/news-perspective/2020/06/report-slams-beef-industry-overuse-antibiotics https://www.cidrap.umn.edu/news-perspective/2020/06/report-s...
- hyperman1 5y ago
  This is one of the contentious points in trade between the USA and the EU: The EU does not allow preventive antibiotic use, but the USA does. Same for growth hormones. As a result, USA meat can not be imported in the EU. USA claims this is foul play, protectionism, against WTO rules. Now the EU does allow curative antibiotic usage on animals, so I wonder if this is actually such a big difference. If a vet prescribes antibiotics for the slightest reason, there might not be much changed in reality.
  - Fomite 5y ago
    This is certainly a problem when banning antibiotics for growth promotion, but allowing the prophylactic use of antibiotics. Any animal in the type of farm looking for growth promotion is at risk for a bacterial infection basically all the time.
- Fomite 5y ago
  It's been funny working at the intersection of human and animal health. The medical types all want to blame agriculture. The agriculture types all respond that they're not using major frontline human antibiotics (outside some stuff for companion animals). It's sort of a complex mix - there's a lot of bulk use in agriculture, but the drug-microorganism pairings in human medicine are somewhat more acute.
MaxBarraclough 5y ago
It seems odd to me that doctors are even allowed to prescribe antibiotics when they know they aren't necessary. Why shouldn't that be grounds for disciplinary action?
- deleted 5y ago
  [deleted]
- cycomanic 5y ago
  That's one of the interesting experiences when moving to Sweden. One is highly unlikely to be prescribed antibiotics here, and one gets prescribed very "old" antibiotics, that my partner who was trained in France said are hardly used anymore in France due to resistances. When she started working as a GP here she found out that it's very hard for doctors to prescribe antibiotics, i.e. the conditions under which doctors are allowed to prescribe them are very strict. There's a lot of things that are frustrating about the medical system here, but the restrictions on antibiotics is one of the very good things.
  - MaxBarraclough 5y ago
    Sounds sensible, but I imagine it won't do much good if it's just Sweden doing it.
    - Zircom 5y ago
      You're right it won't do much good, but it is nice to see a country take a principled stand and actually practice what they preach and be the change they want to see.
nostromo 5y ago
I don't buy that the primary issue is with human antibiotic use. Doctors have become increasingly stingy with antibiotics, sometimes at the expense of human well-being -- meanwhile 80% of antibiotics are used in livestock production. We could reduce the need for antibiotics in livestock if we treated animals better. Giving animals a bit of breathing room and fresh air would reduce the need to jack them up on antibiotics from day one. Reducing use in humans seems like banning straws to take on plastic waste -- a feel good policy that won't actually fix much.
johnisgood 5y ago
Why prescribe it if we know it is viral? First, the doctor should determine whether or not it is viral or bacterial. If it turns out that it is viral, then DO NOT PRESCRIBE ANTIBIOTICS. Is it because of placebo? Because if so, the costs are too high. Tell them to take zinc or whatever for a week.

cortesoft 5y ago

Isn’t this paper actually debunking that argument (That overuse of antibiotics has increased antibiotic resistance)? The paper says that resistance didn’t diminish when antibiotic use was decreased. It seems that our common understanding of how resistance develops was incorrect, at least partially.

commiefornian 5y ago
If there is selective pressure to increase resistance, resistance increases over time. If there is not selective pressure to increase resistance... nothing. There is no pressure to change anything relating to resistance. It could increase. It could decrease. It could stay the same. There is no reason to expect anything in particular about it.

fennecfoxen 5y ago

Well, that’s not covered by my health plan!

snarf21 5y ago

Of course, but the US fee-for-service model is aligned elsewhere. I think a lot of them think that as long as they are not prescribing a z-pack every month, it won't be that big of a deal. Also, customer acquisition is hard. Patients will just find another primary or go to an urgent care and get the meds there. For primary care, being seen as "not helpful" won't just lose one patient, but a whole household of them. As you quote above, people want a quick fix. The person consuming 3000 calories of carbs per day wants a magic pill to fix their type 2 diabetes without them having to make any changes. I don't envy them.

nradov 5y ago
SGLT2 inhibitors pretty much are magic pills for type 2 diabetes. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/sodium-glucose-cotransporter-2-sglt2-inhibitors https://www.fda.gov/drugs/postmarket-drug-safety-information... But of course it's better to prevent the condition in the first place.
- tsol 5y ago
  Wait until people find out the side effects, then you'll get another thread exactly like this one but about SGLT2 inhibitors instead of antibiotics
- orangepurple 5y ago
  Autophagy is the real silver bullet for T2DM treatment but you won't get that from a pill especially if you continue to ingest sugar.
- snarf21 5y ago
  Another very promising treatment for type 2 is DMR. We need to do a lot more research on the duodenum as it is clear it is a major linchpin in type 2. [https://gut.bmj.com/content/69/2/295 https://gut.bmj.com/content/69/2/295]

avgDev 5y ago

I do not understand why there is a huge gap between scientific knowledge and physicians. I had a problem with an allergic reaction to an antibiotic. This resulted in me actually paying attention to drug labels, side effects and what a drug is being prescribed for. It has quite literally ruined my trust in doctors. Last year I had stomach pain, I thought it was appendix. So, I went to an urgent care because my physician could not see me. They had access to my medical records. Quickly, I receive a diagnosis of "Diverticulitis". 2 minutes later I'm given a prescription for Cipro, which I'm deadly allergic to. New guidelines suggest not using antibiotics in uncomplicated diverticulitis. I didn't take the meds, and I'm pretty sure I just pulled an abdomen muscle as it healed over the next few weeks. I have many stories from sports injuries and doctors offering steroid injections as first line treatment, which is no longer recommended. NSAIDs are also not recommended for tendon injuries and it is the first thing the doctor will offer. I don't get it. The information is easily available. Saying I read a study or a updated recommendation gets most doctors visibly upset. Not sure if it is the long working hours and trying to move as many patients as possible or just lack of giving a fuck.

bserge 5y ago
It's both. On the one hand, I hate the fuckers who don't give a shit, I've met way too many of them. On the other hand, too many times they are overworked and/or underpaid. At some point anyone will stop giving a fuck. Surgeons, dentists, EMTs deserve respect though. Yeah they fuck up, but nowhere near as often or bad as those responsible for gatekeeping useful medicine.
peakaboo 5y ago
It's about money and they just want to get rid of you, because they are understaffed, overworked and not happy people.
nradov 5y ago
I don't have the citation handy but the Institute of Medicine researched this and found it takes about 17 years in average to get all physicians to adopt new clinical practice guidelines. For physicians with a wide scope of practice it's just tough to keep up with all the chances. There might be some opportunities to use technology in clinical decision support systems that warn about potentially inappropriate treatments, but those have to be handled carefully so as to not slow down patient care unnecessarily.

beached_whale 5y ago

There was talk to the placebos on SBM at one point, the gist of it being that it would be far worse for them to do so for a few reasons. It erodes trust is the big point. But, I assume, there would be issues with informed consent too. How does one prescribe a placebo where the user can lookup the drug by name online. Not a medical professional, but I think the issue comes down to doctors saying no as a group and being ok if they shop another doctor. If enough do that, the issue goes away.

cogman10 5y ago

I have to wonder, though, if it's human prescribed antibiotics that source these super-bugs. It's pretty common practice in the cattle industry, for example, to just pump cows with antibiotics because studies have shown cows constantly on antibiotics grow fatter than cows not on antibiotics. (Likely, because they don't ever really get sick). [1] That makes me wonder how many of our super bugs have origins in the livestock industries where common practice is literally a recipe to bread superbugs. [1] https://www.cidrap.umn.edu/news-perspective/2020/06/report-slams-beef-industry-overuse-antibiotics https://www.cidrap.umn.edu/news-perspective/2020/06/report-s...

hyperman1 5y ago
This is one of the contentious points in trade between the USA and the EU: The EU does not allow preventive antibiotic use, but the USA does. Same for growth hormones. As a result, USA meat can not be imported in the EU. USA claims this is foul play, protectionism, against WTO rules. Now the EU does allow curative antibiotic usage on animals, so I wonder if this is actually such a big difference. If a vet prescribes antibiotics for the slightest reason, there might not be much changed in reality.
- Fomite 5y ago
  This is certainly a problem when banning antibiotics for growth promotion, but allowing the prophylactic use of antibiotics. Any animal in the type of farm looking for growth promotion is at risk for a bacterial infection basically all the time.
Fomite 5y ago
It's been funny working at the intersection of human and animal health. The medical types all want to blame agriculture. The agriculture types all respond that they're not using major frontline human antibiotics (outside some stuff for companion animals). It's sort of a complex mix - there's a lot of bulk use in agriculture, but the drug-microorganism pairings in human medicine are somewhat more acute.

MaxBarraclough 5y ago

It seems odd to me that doctors are even allowed to prescribe antibiotics when they know they aren't necessary. Why shouldn't that be grounds for disciplinary action?

deleted 5y ago
[deleted]
cycomanic 5y ago
That's one of the interesting experiences when moving to Sweden. One is highly unlikely to be prescribed antibiotics here, and one gets prescribed very "old" antibiotics, that my partner who was trained in France said are hardly used anymore in France due to resistances. When she started working as a GP here she found out that it's very hard for doctors to prescribe antibiotics, i.e. the conditions under which doctors are allowed to prescribe them are very strict. There's a lot of things that are frustrating about the medical system here, but the restrictions on antibiotics is one of the very good things.
- MaxBarraclough 5y ago
  Sounds sensible, but I imagine it won't do much good if it's just Sweden doing it.
  - Zircom 5y ago
    You're right it won't do much good, but it is nice to see a country take a principled stand and actually practice what they preach and be the change they want to see.

nostromo 5y ago

I don't buy that the primary issue is with human antibiotic use. Doctors have become increasingly stingy with antibiotics, sometimes at the expense of human well-being -- meanwhile 80% of antibiotics are used in livestock production. We could reduce the need for antibiotics in livestock if we treated animals better. Giving animals a bit of breathing room and fresh air would reduce the need to jack them up on antibiotics from day one. Reducing use in humans seems like banning straws to take on plastic waste -- a feel good policy that won't actually fix much.

johnisgood 5y ago

Why prescribe it if we know it is viral? First, the doctor should determine whether or not it is viral or bacterial. If it turns out that it is viral, then DO NOT PRESCRIBE ANTIBIOTICS. Is it because of placebo? Because if so, the costs are too high. Tell them to take zinc or whatever for a week.