November 22, 2010
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Learning, one step at a time.
I wanted to fact-check myself. So I did. Turns out, I am not wrong.
Lesson learned here: Don’t accept antibiotics for an infection that has drainage without a culture first. Thank you, Dr. Boe!
Hi Dr. Boe!
I see a handful of people I know going to the doctor with what is probably a viral infection, getting diagnosed with a virus, and then getting prescribed antibiotics “just in case”. I thought doctors try not to prescribe antibiotics without being sure of the bacterial infections actually being there. The reasons I remember are something about how antibiotics aren’t always the most friendly medicines and that they can worsen the problem of antibiotic resistance.
My question deals with the WHY of the matter. Is there something I am missing? Why are they being prescribed antibiotics without testing for bacterial infections?
Thanks!
-Bryan
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Bryan, great question! It is something we as physicians face on a daily basis. If the diagnosis seems to be a viral infection, the physician really should not be prescribing an antibiotic. But… pressure from patients, second guessing your diagnosis can all be reasons we succumb to random antibiotic prescriptions. Once you begin your med school journey, you will hopefully see that at least in Academics, the bent is to try to educate patients about the futility of antibiotic treatment for a virus. Essentially, this is one of the biggest reasons we are having antibiotic resistance today. Great job for putting your finger on the problem! Take care,
Ruth———————
Thanks for your reply!Hm. If a doctor feels like second guessing a diagnosis, wouldn’t a suitable solution be to do a throat culture to check for the presence of a bacterial infection? And that would only work for a respiratory tract infection, right?
Thank you,
-Bryan———————
Bryan, a culture is absolutely right. A great rule to follow is always culture before an antibiotic prescription. Of course, sometimes it is not possible to culture, like with a middle or inner ear infection or a skin infection without any drainage to culture. That’s when you need to know which bacteria you think is causing the infection and then which antibiotic will kill that bacteria. And that will be a lot of what you will be learning in the next few years! Good luck! RuthI love the confidence she has in my future. I feel like this information will come in handy for me someday.
-b.
Comments (6)
I agree, the fact that different antibiotics work best against different bacteria is often misunderstood. Most people assume that amoxicillin or azithromycin is always the best choice, when in fact they might have a viral infection & not need antibiotics at all.
Also, with the swine flu scare of the past few years, we’ve seen many prescriptions for brand-name-only Tamiflu. We’ve had patients come in with Tamiflu rx’s to put them on hold, ”just in case they get the swine flu.” So the next time the patient gets sick, they “self medicate” with pre-prescribed anti-viral medication. I don’t recall having a patient come in the pharmacy with symptoms congruent with swine flu, however we sold it by the boatload.
I wish patients would leave the diagnosing to the doctors, and doctors would not so easily give in to patient demands.
/end rant
@nerdyveggiegirl -
Haha yes, yes. I agree completely!
Luckily, most of the doctors that I have had the pleasure of shadowing and working for personally have been wonderful, caring individuals who are careful because they are very aware of that their patients’ wellbeing is being trusted to them. Whew! That was a lot of unclear antecedents.
o0o0o this may come in handy for me too. Just as general medic knowledge.
@Rhia_Pyrithea -
More general medical knowledge is always useful.
hey…got a new protected post up. let me know if you want to see it.
@jtqueenbee30 -
Sure!