3 ms·

ICU doctor here. I frequently see complications of overuse of antibiotics. C diff colitis (1) is certainly the most obvious, but resistant pneumonias and urina

by davak 13y ago

ICU doctor here. I frequently see complications of overuse of antibiotics. C diff colitis (1) is certainly the most obvious, but resistant pneumonias and urinary tract infections are becoming more common as well. Many resistant organisms set up shop in chronically ill patients who see multiple rounds of antibiotics through their lives; however, in just my short 10 year history as a physician, the increasing amount of resistant staphylococcus (specifically MRSA) and VRE (2) found out in the community has changed how we treat many suspected infections. Although some of this is due to overprescription by the healthcare profession, there are likely other selection components in our environment. Just as you can buy these antibiotics for animal use, so can people raising livestock. The FDA realizes this is a problem. (3) Personally, the sad part to me is that our medical system is so expensive that treating routine, mild infections can cost hundreds of dollars. Thus, people search out these alternative riskier, but cheaper methods. (1)http://en.wikipedia.org/wiki/Clostridium_difficile http://en.wikipedia.org/wiki/Clostridium_difficile (2)http://switchboard.nrdc.org/blogs/slyutse/resistance%20graph.jpg http://switchboard.nrdc.org/blogs/slyutse/resistance%20graph... (3)http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm378100.htm http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm378100.ht...

conductr 13y ago
Curious: Do these problems exist in other countries where even strong antibiotics are sold OTC? I would guess not as bad, the culture in the US is to medicate immediately at first sign of illness. When I get sick, I try to just let it run it's course.
- DanBC 13y ago
  India has a serious problem with some antibiotic resistant illnesses because many people are too poor to buy a full course but are convinced of tbe efficacy of a few days of treatment. But overuse of antibiotics for things like ear infections is also part of the problem too.
- gautamc 13y ago
  When I was in India I got antibiotics OTC a few times for myself after I self diagnosed using the internet. Because my mum went to med-school I was always very aware about the need to complete the course. I am sure that not everybody is as careful: http://ibnlive.in.com/blogs/shalini/211/65030/anitbiotic-resistance-in-india-are-there-solutions.html http://ibnlive.in.com/blogs/shalini/211/65030/anitbiotic-res... In India there are lots of doctors running small individual practices, due to this for simple diagnosis and prescription they would charge a small fee in cash and be done with it. Infact, I know for a fact that the Ayurvedic doctor near our house used to charge less than the standard Doctor. When I came to the US, I found things here to be more restrictive - but I guess in the interest of safety we have to accept these restrictions.
- nathanvanfleet 13y ago
  Or does it exist in places where medical care is cheap or free (Canada or the UK)?
  - davak 13y ago
    The last I checked Canada didn't have near the problem with MRSA that the US has: "Similarly the United States has major problems with methicillin-resistant S aureus, vancomycin-resistant enterococci, multidrug-resistant M tuberculosis and penicillin-resistant pneumococci, whereas in Canada there is very little resistance to any of these organisms." (1) That being said, it's a very multifactorial issue so it's hard to know exactly why that is. Canada's health care is more available and more regulated. Is it that people have an easier way of getting checked, is it that not-for-profit systems have less pressure to over-prescribe antibiotics, or something else? 1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3327906/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3327906/
  - Fomite 13y ago
    Having recently been to an international Epidemiology conference, I can say that there's intense interest/concern from researchers in the UK and Europe about both MRSA and carbapenem-resistant Enterobacteriaceae. For that matter, the current strain of C. difficile which is causing so many problems was first observed in the UK and Canada.
    - tommu 13y ago
      Was it first observed and reported in these countries because they have socialized healthcare?
      - Fomite 13y ago
        Unlikely, as surveillance for C. difficile is pretty intensive in the U.S., and it was reported there shortly thereafter (which isn't particularly a surprise).
- davak 13y ago
  Yes. Multidrug resistance in TB is frequently related to the availability of antibiotics.
larrys 13y ago
My wife the same. She is all over this issue with me and sees it just as well in her rounds.

by davak 13y ago

conductr 13y ago

Curious: Do these problems exist in other countries where even strong antibiotics are sold OTC? I would guess not as bad, the culture in the US is to medicate immediately at first sign of illness. When I get sick, I try to just let it run it's course.

DanBC 13y ago
India has a serious problem with some antibiotic resistant illnesses because many people are too poor to buy a full course but are convinced of tbe efficacy of a few days of treatment. But overuse of antibiotics for things like ear infections is also part of the problem too.
gautamc 13y ago
When I was in India I got antibiotics OTC a few times for myself after I self diagnosed using the internet. Because my mum went to med-school I was always very aware about the need to complete the course. I am sure that not everybody is as careful: http://ibnlive.in.com/blogs/shalini/211/65030/anitbiotic-resistance-in-india-are-there-solutions.html http://ibnlive.in.com/blogs/shalini/211/65030/anitbiotic-res... In India there are lots of doctors running small individual practices, due to this for simple diagnosis and prescription they would charge a small fee in cash and be done with it. Infact, I know for a fact that the Ayurvedic doctor near our house used to charge less than the standard Doctor. When I came to the US, I found things here to be more restrictive - but I guess in the interest of safety we have to accept these restrictions.
nathanvanfleet 13y ago
Or does it exist in places where medical care is cheap or free (Canada or the UK)?
- davak 13y ago
  The last I checked Canada didn't have near the problem with MRSA that the US has: "Similarly the United States has major problems with methicillin-resistant S aureus, vancomycin-resistant enterococci, multidrug-resistant M tuberculosis and penicillin-resistant pneumococci, whereas in Canada there is very little resistance to any of these organisms." (1) That being said, it's a very multifactorial issue so it's hard to know exactly why that is. Canada's health care is more available and more regulated. Is it that people have an easier way of getting checked, is it that not-for-profit systems have less pressure to over-prescribe antibiotics, or something else? 1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3327906/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3327906/
- Fomite 13y ago
  Having recently been to an international Epidemiology conference, I can say that there's intense interest/concern from researchers in the UK and Europe about both MRSA and carbapenem-resistant Enterobacteriaceae. For that matter, the current strain of C. difficile which is causing so many problems was first observed in the UK and Canada.
  - tommu 13y ago
    Was it first observed and reported in these countries because they have socialized healthcare?
    - Fomite 13y ago
      Unlikely, as surveillance for C. difficile is pretty intensive in the U.S., and it was reported there shortly thereafter (which isn't particularly a surprise).
davak 13y ago
Yes. Multidrug resistance in TB is frequently related to the availability of antibiotics.

larrys 13y ago

My wife the same. She is all over this issue with me and sees it just as well in her rounds.