In India, you can still buy antibiotics over the counter.
http://www.npr.org/sections/goatsandsoda/2015/09/17/44114639...
- Differentiating "common cold" (viral infection) from a bacterial infection, which would be a correct indication for antibiotics, is often impossible. If you want the best chance for your particular patient, what will you do? Now, if you want the best chance for the whole patient population, what will you do? Not the same thing.
- If you don't give antibiotics, things turn wrong, and the patient's family comes back wielding pitchforks, what do you do? This is less of a problem nowadays, but in small communities and rural environments can still be a very real question.
This is also a bit of a cultural issue. Now, I agree completely that OTC antibiotics make no sense at all.
Of course this doesn't necessarily generalise, but there's plenty of older english people with the "I don't want to be a bother" mindset so it might do better than you think.
I am curious if this is true, ie: does medical science hold above as an accepted fact by general consensus?
I ask because my understanding is that the 1918 flu (aka Spanish flu) which was an H1N1 (upper respiratory infection in humans , intestinal tract in birds) predominantly killed young adults, ie: healthy non-immunocompromised people. Here's the wikipedia remark:
https://en.wikipedia.org/wiki/1918_flu_pandemic
"the 1918 pandemic predominantly killed previously healthy young adults."
"a rapid progressive respiratory failure and death through a cytokine storm (overreaction of the body's immune system). It was then postulated that the strong immune reactions of young adults ravaged the body, whereas the weaker immune systems of children and middle-aged adults resulted in fewer deaths among those groups"
But there's some conflicting explanations: "special circumstances (malnourishment, overcrowded medical camps and hospitals, poor hygiene) promoted bacterial superinfection that killed most of the victims typically after a somewhat prolonged death bed "
You've got to remember, too, that it wasn't an especially virulent strain of influenza alone that caused the deaths from 1917-1919. It spread quickly among the war-weary, crowded, exposure-riddled young men who lived with chickens and hogs at the battlefronts. It was common practice at the time to logistically set up small-pen animals close to the long, mostly stable fronts as a source of local food rather than shipping in so much preserved food. Those young men then travelled far and wide across the continent and even overseas as their service rotations came and especially when hostilities ceased.
https://virus.stanford.edu/uda/ tells the story about as well and succinctly as any source. http://ww1centenary.oucs.ox.ac.uk/body-and-mind/the-spanish-... and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862337/ have lots of information.
As is common, the war's conditions and aftereffects killed far more people than died in combat. It was a nasty flu, but humans helped it out about the best we could.
1/5 chance it's Group A strep and worth throwing abx at. And... then what? We know the stats, we have a non-specific presentation, and the traditional reason to throw abx at this patient is because we want to minimize the chance of a subsequent heart or kidney disease (post-infectious immune hypersensitivity rxn). 4/5 chance they don't need abx; 1/5 chance that they'll benefit, but not a lot. But, hey,... how do you even attach a utility analysis to "and a small reduction in the likelihood of heart and/or kidney damage"? The magnitude of the risk is hard to comprehend, subjectively, in the face of the small reduction in incidence. And you will see those consequences play out; you're going to see so many sore throats that the small odds will manifest.
This isn't one of those, "stupid doctors, they don't know what they're doing!" things. It's something that doesn't readily yield to utility metrics.
...which is a big part of why it used to be common, and isn't now.
It's called the "ZeePack" or something of the sort (a play on the the azithromycin/zithromax 'Z-Pak') and is essentially vitamins and herbal supplements you can give to cold patients so they feel like they have been given something.
That kind of rates.
In the 1918 influenza pandemics for example, many people died of a bacterial pneumonia following the flu infection. So you see, the impact of "1-tier" infections is very real without antibiotics.
EDIT: by all means, downvoters, make your point explicit!
http://www.fda.gov/Drugs/DrugSafety/ucm341822.htm
Seems like one of the primary features of this antibiotic was to have a chemical that was new at the time, so patent protection could be enjoyed from that point forward.
Different features can have different priorities at different times, sometimes there's nothing "engineering" can do about it, it's a marketing thing.
Wherever cardiac health might fall on the priorities list, it's probably not way up there for this compound.
disclaimer: haven't worked for a drug producer since I was first out of college