5 ms·

It kind of worries me when people talk about reduction in prescription of antibiotics. If we are talking about primarily about false diagnoses and prescription

by belorn 4y ago

It kind of worries me when people talk about reduction in prescription of antibiotics. If we are talking about primarily about false diagnoses and prescription of antibiotics when there exist equal or better treatment plans, then a reduction in antibiotics is good. The day when people got antibiotics in order to treat a cold is hopefully over. The cases that worries me most is however debilitating chronic illnesses (where antibiotics is used as a stop gap until medical science find a cure), and illnesses which if let untreated might turn into a debilitating chronic problem. I hope they are keeping a close watch on the outcomes from those younger MDs. Antibiotics in animal farming is obviously terrible. Animals should not be allowed to be kept unless it is in an environment that is safe and healthy for them. Antibiotics is a tool used to fix how poor some large scale farmers treat their animals.

gwerbret 4y ago
> The cases that worries me most is however debilitating chronic illnesses (where antibiotics is used as a stop gap until medical science find a cure) Which debilitating, non-bacterial chronic illnesses are treated with antibiotics as a stopgap measure?
- NikolaNovak 4y ago
  Controversially but famously, "chronic Lyme disease" involves course of multiple super strong antibiotics over potentially years. Then things to try to save your organs from antibiotics. Then pills to help you digest those. Taking 50 pills on regular basis is apparently common enough.
- Teever 4y ago
  not necessarily debilitating, but current treatments for rosacea include a low dose prescription of antibiotics like doxycycline, basically forever.
  - NikolaNovak 4y ago
    I have rosacea and it of course goes up and down. used tgel for a while then decided to only apply it to my right side of face. After a ~year there was never ever difference between two sides of my face, they went up and down together depending on temperature, environment, sweat, stress, food, etc. My doctor could not believe that I would try that, but it seemed a super simple way to check if all those antibiotics actually Did anything. For me at least they didn't.
- sterlind 4y ago
  acne is bacterial but chronic. it's standard practice for dermatologists to prescribe long-term antibiotics for severe acne, rather than turn to accutane.
- belorn 4y ago
  Any non-treatble illness that causes a buildup/environment for bacteria that trigger debilitating symptoms. The human body has many defenses and mechanics to keep bacteria in balance. I would point particularly towards the gut/intestant, the skin, ears, anus, bladder and genitalia for places where bacteria need to be constatly kept at the correct balance. Some things are treatable. Some things are possible to cut off. Some things are less known/fixable, in which case symptoms is the only thing possible to addressed at this time.
sterlind 4y ago
iirc antibiotics in cows are not principally used as medicine. it's because chronic antibiotic use makes cows put on weight faster. I don't know the mechanism.
- bell-cot 4y ago
  Similar recollection here. So, obvious question - would it work to standardize on giving the cows some old, seldom-useful-in-human-medicine antibiotic? If yes, that would seem to minimize the resulting harm to human health...
  - samus 4y ago
    If these older antibiotics would stop being used, they could eventually be used on humans again. Maintaining chemical defenses is an evolutionary disadvantage compared to populations without them if the antibioticum is not present in the environment anymore.
- pixl97 4y ago
  It would be interesting to know of this mechanism has any effect in humans, being that humans are eating more meat that's been treated with antibiotics and were also gaining weight at rapid levels at society wide levels.
  - thelittleone 4y ago
    I'm curious also. Could it be that antibiotic meats affect the gut / microbiome? Perhaps creating an environment favorable to certain gut bacteria that lead to increased appetite or fat?
giantg2 4y ago
Many doctors don't bother to test if the infection is bacterial or viral or fungal (outside of covid, flu, rsv, and some others). My wife had an outer ear infection. The doctor confirmed it was an outer ear infection, then prescribed antibiotic drops. They didn't do any test. It could be bacterial or it could be fungal. If fungal, the antibiotics will actually make it worse. So my wife uses the drops for several days and gets worse. What's the solution? Mix half distilled white vinegar (5% concentration) and half 91% isopropyl alcohol (or 190 proof ethanol). This is a cheap solution which is generally effective for both fungal and bacterial outer ear infections. She was better in less than week.
- saxonww 4y ago
  +1 on the alcohol/vinegar. If you've had one of these outer ear infections you'll remember what it felt like early on, so you're probably able to tell when it feels like you might be getting another one. Start using the alcohol/vinegar mixture immediately, and you might avoid the infection altogether. If you've never had one of these - you do not want to get one. They can be extremely painful.
- chasil 4y ago
  Wouldn't it be better to use them separately? I remember from high school organic chemistry that an acid combined with a base yields a water and a salt, but and acid combined with an alcohol yields a water and an ester. https://en.m.wikipedia.org/wiki/Ester https://en.m.wikipedia.org/wiki/Ester "Esterification is the general name for a chemical reaction in which two reactants (typically an alcohol and an acid) form an ester as the reaction product."
  - giantg2 4y ago
    Esters tend to evaporate quickly, right? That's part of the benefit of the drops is to dry the ear out. I haven't heard of them being applied separately. I would be a little careful since applying them separately means increasing the strength of the acid and alcohol.
- belorn 4y ago
  Over 90% of outer ear infection is caused by bacterial infection, with 10% being fungal (and then, those are more liekly in tropical environments). The risk of fungal infection in non-tropical environments is thus fairly low probability. There has also been several (4 that I can find myself) studies done on using acidic drops as the only treatment for ear infections, all which has shown them non-effective to clear an infection. Alcohol can also irritate the skin further, increasing inflammation. Ear infections are however complex since most of the studies are either done on children, commercial or military divers. The military protocol in the Netherlands is to start with an acidic solution and then if the inflammation get worse introduce steroids. If that doesn't clear it, then add a combination of antibiotics and steroids. Steroids has the problem of increasing risk to bacterial infection, but the combination of using antibiotics with the steroids reduces that risk. It is this combination that doctors use in post surgery. The Dutch protocol seems like the optimal treatment protocol for now, but it assumes you got a doctor to monitor it. My guess is that regular doctors jumps to the last step with the assumption that it is bacterial infection in order to minimize the need for further visits. One study I read also mentioned that adherence to correct application of the drops was one of the most significant factor in outcomes, which might imply an other reason to go for the strongest treatment first. One thing that favors alcohol however is that keeping the ear dry is extremely important in addressing outer ear infection and preventing bacteria from growing. The theory behind vinegar and alcohol does thus seem quite sound from a theory perspective, stopping the bacterial infection before it get a chance to grow.
pyuser583 4y ago
Antibiotics are given to animals to promote growth, not (just) treat disease. When livestock get sick, they are “culled,” not treated. Which makes the use of antibiotics (“growth promoting anti-microbials”) all that more outrageous.
- samus 4y ago
  Depends on the economic value of the livestock. For example, a milk cow is probably economically worth being treated. Even if there are regulations that ban selling their milk, they can still be used for breeding.

by belorn 4y ago

gwerbret 4y ago

> The cases that worries me most is however debilitating chronic illnesses (where antibiotics is used as a stop gap until medical science find a cure) Which debilitating, non-bacterial chronic illnesses are treated with antibiotics as a stopgap measure?

NikolaNovak 4y ago
Controversially but famously, "chronic Lyme disease" involves course of multiple super strong antibiotics over potentially years. Then things to try to save your organs from antibiotics. Then pills to help you digest those. Taking 50 pills on regular basis is apparently common enough.
Teever 4y ago
not necessarily debilitating, but current treatments for rosacea include a low dose prescription of antibiotics like doxycycline, basically forever.
- NikolaNovak 4y ago
  I have rosacea and it of course goes up and down. used tgel for a while then decided to only apply it to my right side of face. After a ~year there was never ever difference between two sides of my face, they went up and down together depending on temperature, environment, sweat, stress, food, etc. My doctor could not believe that I would try that, but it seemed a super simple way to check if all those antibiotics actually Did anything. For me at least they didn't.
sterlind 4y ago
acne is bacterial but chronic. it's standard practice for dermatologists to prescribe long-term antibiotics for severe acne, rather than turn to accutane.
belorn 4y ago
Any non-treatble illness that causes a buildup/environment for bacteria that trigger debilitating symptoms. The human body has many defenses and mechanics to keep bacteria in balance. I would point particularly towards the gut/intestant, the skin, ears, anus, bladder and genitalia for places where bacteria need to be constatly kept at the correct balance. Some things are treatable. Some things are possible to cut off. Some things are less known/fixable, in which case symptoms is the only thing possible to addressed at this time.

sterlind 4y ago

iirc antibiotics in cows are not principally used as medicine. it's because chronic antibiotic use makes cows put on weight faster. I don't know the mechanism.

bell-cot 4y ago
Similar recollection here. So, obvious question - would it work to standardize on giving the cows some old, seldom-useful-in-human-medicine antibiotic? If yes, that would seem to minimize the resulting harm to human health...
- samus 4y ago
  If these older antibiotics would stop being used, they could eventually be used on humans again. Maintaining chemical defenses is an evolutionary disadvantage compared to populations without them if the antibioticum is not present in the environment anymore.
pixl97 4y ago
It would be interesting to know of this mechanism has any effect in humans, being that humans are eating more meat that's been treated with antibiotics and were also gaining weight at rapid levels at society wide levels.
- thelittleone 4y ago
  I'm curious also. Could it be that antibiotic meats affect the gut / microbiome? Perhaps creating an environment favorable to certain gut bacteria that lead to increased appetite or fat?

giantg2 4y ago

Many doctors don't bother to test if the infection is bacterial or viral or fungal (outside of covid, flu, rsv, and some others). My wife had an outer ear infection. The doctor confirmed it was an outer ear infection, then prescribed antibiotic drops. They didn't do any test. It could be bacterial or it could be fungal. If fungal, the antibiotics will actually make it worse. So my wife uses the drops for several days and gets worse. What's the solution? Mix half distilled white vinegar (5% concentration) and half 91% isopropyl alcohol (or 190 proof ethanol). This is a cheap solution which is generally effective for both fungal and bacterial outer ear infections. She was better in less than week.

saxonww 4y ago
+1 on the alcohol/vinegar. If you've had one of these outer ear infections you'll remember what it felt like early on, so you're probably able to tell when it feels like you might be getting another one. Start using the alcohol/vinegar mixture immediately, and you might avoid the infection altogether. If you've never had one of these - you do not want to get one. They can be extremely painful.
chasil 4y ago
Wouldn't it be better to use them separately? I remember from high school organic chemistry that an acid combined with a base yields a water and a salt, but and acid combined with an alcohol yields a water and an ester. https://en.m.wikipedia.org/wiki/Ester https://en.m.wikipedia.org/wiki/Ester "Esterification is the general name for a chemical reaction in which two reactants (typically an alcohol and an acid) form an ester as the reaction product."
- giantg2 4y ago
  Esters tend to evaporate quickly, right? That's part of the benefit of the drops is to dry the ear out. I haven't heard of them being applied separately. I would be a little careful since applying them separately means increasing the strength of the acid and alcohol.
belorn 4y ago
Over 90% of outer ear infection is caused by bacterial infection, with 10% being fungal (and then, those are more liekly in tropical environments). The risk of fungal infection in non-tropical environments is thus fairly low probability. There has also been several (4 that I can find myself) studies done on using acidic drops as the only treatment for ear infections, all which has shown them non-effective to clear an infection. Alcohol can also irritate the skin further, increasing inflammation. Ear infections are however complex since most of the studies are either done on children, commercial or military divers. The military protocol in the Netherlands is to start with an acidic solution and then if the inflammation get worse introduce steroids. If that doesn't clear it, then add a combination of antibiotics and steroids. Steroids has the problem of increasing risk to bacterial infection, but the combination of using antibiotics with the steroids reduces that risk. It is this combination that doctors use in post surgery. The Dutch protocol seems like the optimal treatment protocol for now, but it assumes you got a doctor to monitor it. My guess is that regular doctors jumps to the last step with the assumption that it is bacterial infection in order to minimize the need for further visits. One study I read also mentioned that adherence to correct application of the drops was one of the most significant factor in outcomes, which might imply an other reason to go for the strongest treatment first. One thing that favors alcohol however is that keeping the ear dry is extremely important in addressing outer ear infection and preventing bacteria from growing. The theory behind vinegar and alcohol does thus seem quite sound from a theory perspective, stopping the bacterial infection before it get a chance to grow.

pyuser583 4y ago

Antibiotics are given to animals to promote growth, not (just) treat disease. When livestock get sick, they are “culled,” not treated. Which makes the use of antibiotics (“growth promoting anti-microbials”) all that more outrageous.

samus 4y ago
Depends on the economic value of the livestock. For example, a milk cow is probably economically worth being treated. Even if there are regulations that ban selling their milk, they can still be used for breeding.