6 ms·

What I find most interesting about this story that antibiotics weren't given when the patient had persistent inflammation and a clear cause couldn't be identifi

by dtech 1y ago

What I find most interesting about this story that antibiotics weren't given when the patient had persistent inflammation and a clear cause couldn't be identified. It seems like such a common low risk treatment just to try. Especially curious why auto immune was assumed instead.

typingonmyphone 1y ago
Had this been in the US, good chance would have received doxycycline as first line treatment and the leptospirosis identified by metagenomic sequencing would have resolved
ajb 1y ago
We don't actually know that they didn't try first-line antibiotics. My guess is that they did, and it's one of the things that didn't work. The UK is a bit cautious about causing antibiotic resistance, but my understanding is that that's more of an issue with long term use so may not be the determining factor here.
ars 1y ago
This surprised me also, till I realized the story was in the UK. From my understanding it's much less common to get antibiotics in the UK vs US.
- OJFord 1y ago
  There's concern of resistance taken seriously for sure, but it's not like people are making out here - I had fluclox prescribed after an online consultation in Jan (for probable cellulitis) - they don't give it out like candy, but when it's indicated... Maybe they tried something broad spectrum here, and what was necessary (and required the sequencing to know what it actually was) was something more targeted.
  - philjohn 1y ago
    Yep - the UK prescribing guidelines from NICE are eminently sensible as a way of staving off antibiotic armaggedon. One example of the guidance: https://elearning.rcgp.org.uk/pluginfile.php/199275/mod_book/chapter/823/NICE_UKHSA%20APG%20summary%20table%20content%20only_30%20Jan%202024.pdf https://elearning.rcgp.org.uk/pluginfile.php/199275/mod_book...
- MattPalmer1086 1y ago
  It does feel like they don't hand them out as often as they used to. I've had 4 infections this year, including an ear infection, fingernail, chest (that caused pneumonia on my son) and one that caused my left eye to swell up. I received no antibiotics for any of them, just a suggestion that if they didn't go away they might prescribe some. They all got better without them (except my son, who ended up in emergency and was given two different ones which cleared up his infection rapidly). In the past though I'm pretty sure I would have been prescribed them immediately.
  - swores 1y ago
    It's an intentional policy shift that has come not only as guidance to medical professionals, but as an awareness campaign (posters in pharmacies etc.) to the general public that most minor infections don't need antibiotics, and so ones that the body should be able to deal with on its own will no longer be prescribed antibiotics. It used to be that they were prescribed much more freely, because on the level of an individual case it's unlikely to do any harm and might help speed up getting better, and it was an easy way for doctors to make patients feel cared for to send them off with a prescription. But sensibly that's been course corrected now.
    - MattPalmer1086 1y ago
      Yep, agreed we should not hand them out like candy due to antibiotic resistance. Mostly it's fine. A related problem though is how hard it is to get an appointment with a doctor now. This is essentially why my son ended up in emergency.
tekla 1y ago
> In 2019, while still at medical school, Ellie began suffering from inflammation in her right eye. All tests for infection came back negative and it was assumed she had an autoimmune condition. You know how everyone complains about antibiotic resistance? Yeah, they're not going to give some random antibiotic if they have no idea what something might be.
- londons_explore 1y ago
  Antibiotic resistance is a problem for society. Infection is a problem for the individual. Modern medical ethics requires you always prioritise the individual over society, which means one should always give antibiotics if the benefits outweigh the downsides for this specific patient, even if that means you might cause antibiotic resistance for everyone else in the future.
  - tekla 1y ago
    What is a society if not a collection of individuals? You don't get to complain about antibiotic resistance if at the first sign of an issue you demand a bathing in random antibiotics, especially if you don't even know if you have a bacterial infection in the first place
    - Hnrobert42 1y ago
      As long as the patient completes the course of antibiotics properly, taking antibiotics should not contribute to antibiotic resistance.
      - londons_explore 1y ago
        I don't think there is much solid science behind that claim. Antibiotic resistance could just as easily first happen in the sewers and other places where there is a lowish concentration of antibiotics.
        1y ago
jghn 1y ago
antibiotic resistance is such that it is increasingly less common to use it as just a "take 2 of these and call me in the morning" shot in the dark treatment.
- like_any_other 1y ago
  If the symptoms are a sore throat, yes. If they're going blind, we can take a chance with antibiotics.
nsagent 1y ago
Good question. I started having digestive issues a year and a half ago. Went to various doctors and according to their lab tests was told everything was fine, that maybe this was my "new normal." Recently had an infection that necessitated broad spectrum antibiotics and magically my digestion issues have cleared up... If not for getting sick recently I'd probably still be dealing with whatever gut infection I had that the doctors essentially ignored.
- Aurornis 1y ago
  > Recently had an infection that necessitated broad spectrum antibiotics and magically my digestion issues have cleared up... There are non-absorbable antibiotics designed to target intestinal bacterial overgrowth. It’s hit or miss, though. Unfortunately for many people, taking antibiotics can have the opposite effect where it creates or worsens gut problems. It’s not an easy or reliable solution.
- 2Gkashmiri 1y ago
  My family has been testing various food items and it was found: .dressed chicken .peanuts .soyabean oil .cumin And we used to use these food "daily". The allergy eruptions, digestive issues went from 100 to 5 starting next day. This is such a small thing to check but it has saved us as a lot of trouble.
  - swores 1y ago
    Could you clarify what you mean by "dressed chicken"? And I'm curious, did all of your family find yourselves allergic or sensitive to all of those things, or is that list a combination that covers everyone while each individual was allergic to one or a few of them?
    - 2Gkashmiri 1y ago
      One member did an allergy test and that found us major allergens. Rest of family just stopped eating those same things and things got better for everyone. Dressed chicken, I meant to say broiler chicken. They are raised for the sole purpose of meat and the turnaround time is in 45 days or less now. They pump these birds full of lots of medication, vaccines and stuff. Everyone in the family gets sick eating them. OTOH, farm chicken that are naturally grown and have no medication is fine so its not chicken per se but maybe some medication or food given to these broiler chicken
sushid 1y ago
Not to mention she swam in untreated water in the Amazon!!
CJefferson 1y ago
I don’t know the details of this story, but I had an illness, and tried some antibiotics with no success. After a whole bunch more tests they decided it was a bacterial infection which had buried itself deep in my digestive system somewhere, and killing it required Fluoroquinolone —- which causes serious tendon damage in many people who take it. It cleaned up my infection, and I didn’t have any side effects —- but hard to shift illnesses can require significant amounts of antibiotics with significant side effects.

by dtech 1y ago

typingonmyphone 1y ago

Had this been in the US, good chance would have received doxycycline as first line treatment and the leptospirosis identified by metagenomic sequencing would have resolved

ajb 1y ago

We don't actually know that they didn't try first-line antibiotics. My guess is that they did, and it's one of the things that didn't work. The UK is a bit cautious about causing antibiotic resistance, but my understanding is that that's more of an issue with long term use so may not be the determining factor here.

ars 1y ago

This surprised me also, till I realized the story was in the UK. From my understanding it's much less common to get antibiotics in the UK vs US.

OJFord 1y ago
There's concern of resistance taken seriously for sure, but it's not like people are making out here - I had fluclox prescribed after an online consultation in Jan (for probable cellulitis) - they don't give it out like candy, but when it's indicated... Maybe they tried something broad spectrum here, and what was necessary (and required the sequencing to know what it actually was) was something more targeted.
- philjohn 1y ago
  Yep - the UK prescribing guidelines from NICE are eminently sensible as a way of staving off antibiotic armaggedon. One example of the guidance: https://elearning.rcgp.org.uk/pluginfile.php/199275/mod_book/chapter/823/NICE_UKHSA%20APG%20summary%20table%20content%20only_30%20Jan%202024.pdf https://elearning.rcgp.org.uk/pluginfile.php/199275/mod_book...
MattPalmer1086 1y ago
It does feel like they don't hand them out as often as they used to. I've had 4 infections this year, including an ear infection, fingernail, chest (that caused pneumonia on my son) and one that caused my left eye to swell up. I received no antibiotics for any of them, just a suggestion that if they didn't go away they might prescribe some. They all got better without them (except my son, who ended up in emergency and was given two different ones which cleared up his infection rapidly). In the past though I'm pretty sure I would have been prescribed them immediately.
- swores 1y ago
  It's an intentional policy shift that has come not only as guidance to medical professionals, but as an awareness campaign (posters in pharmacies etc.) to the general public that most minor infections don't need antibiotics, and so ones that the body should be able to deal with on its own will no longer be prescribed antibiotics. It used to be that they were prescribed much more freely, because on the level of an individual case it's unlikely to do any harm and might help speed up getting better, and it was an easy way for doctors to make patients feel cared for to send them off with a prescription. But sensibly that's been course corrected now.
  - MattPalmer1086 1y ago
    Yep, agreed we should not hand them out like candy due to antibiotic resistance. Mostly it's fine. A related problem though is how hard it is to get an appointment with a doctor now. This is essentially why my son ended up in emergency.

tekla 1y ago

> In 2019, while still at medical school, Ellie began suffering from inflammation in her right eye. All tests for infection came back negative and it was assumed she had an autoimmune condition. You know how everyone complains about antibiotic resistance? Yeah, they're not going to give some random antibiotic if they have no idea what something might be.

londons_explore 1y ago
Antibiotic resistance is a problem for society. Infection is a problem for the individual. Modern medical ethics requires you always prioritise the individual over society, which means one should always give antibiotics if the benefits outweigh the downsides for this specific patient, even if that means you might cause antibiotic resistance for everyone else in the future.
- tekla 1y ago
  What is a society if not a collection of individuals? You don't get to complain about antibiotic resistance if at the first sign of an issue you demand a bathing in random antibiotics, especially if you don't even know if you have a bacterial infection in the first place
  - Hnrobert42 1y ago
    As long as the patient completes the course of antibiotics properly, taking antibiotics should not contribute to antibiotic resistance.
    - londons_explore 1y ago
      I don't think there is much solid science behind that claim. Antibiotic resistance could just as easily first happen in the sewers and other places where there is a lowish concentration of antibiotics.
      - 1y ago

jghn 1y ago

antibiotic resistance is such that it is increasingly less common to use it as just a "take 2 of these and call me in the morning" shot in the dark treatment.

like_any_other 1y ago
If the symptoms are a sore throat, yes. If they're going blind, we can take a chance with antibiotics.

nsagent 1y ago

Good question. I started having digestive issues a year and a half ago. Went to various doctors and according to their lab tests was told everything was fine, that maybe this was my "new normal." Recently had an infection that necessitated broad spectrum antibiotics and magically my digestion issues have cleared up... If not for getting sick recently I'd probably still be dealing with whatever gut infection I had that the doctors essentially ignored.

Aurornis 1y ago
> Recently had an infection that necessitated broad spectrum antibiotics and magically my digestion issues have cleared up... There are non-absorbable antibiotics designed to target intestinal bacterial overgrowth. It’s hit or miss, though. Unfortunately for many people, taking antibiotics can have the opposite effect where it creates or worsens gut problems. It’s not an easy or reliable solution.
2Gkashmiri 1y ago
My family has been testing various food items and it was found: .dressed chicken .peanuts .soyabean oil .cumin And we used to use these food "daily". The allergy eruptions, digestive issues went from 100 to 5 starting next day. This is such a small thing to check but it has saved us as a lot of trouble.
- swores 1y ago
  Could you clarify what you mean by "dressed chicken"? And I'm curious, did all of your family find yourselves allergic or sensitive to all of those things, or is that list a combination that covers everyone while each individual was allergic to one or a few of them?
  - 2Gkashmiri 1y ago
    One member did an allergy test and that found us major allergens. Rest of family just stopped eating those same things and things got better for everyone. Dressed chicken, I meant to say broiler chicken. They are raised for the sole purpose of meat and the turnaround time is in 45 days or less now. They pump these birds full of lots of medication, vaccines and stuff. Everyone in the family gets sick eating them. OTOH, farm chicken that are naturally grown and have no medication is fine so its not chicken per se but maybe some medication or food given to these broiler chicken

sushid 1y ago

Not to mention she swam in untreated water in the Amazon!!

CJefferson 1y ago

I don’t know the details of this story, but I had an illness, and tried some antibiotics with no success. After a whole bunch more tests they decided it was a bacterial infection which had buried itself deep in my digestive system somewhere, and killing it required Fluoroquinolone —- which causes serious tendon damage in many people who take it. It cleaned up my infection, and I didn’t have any side effects —- but hard to shift illnesses can require significant amounts of antibiotics with significant side effects.