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Comment by chiph | Hacker News Reader

Stop administering them whenever anyone gets a sniffle so they stay effective longer. Also firmly separate veterinary antibiotic classes from human antibiotics so that the ones intended for humans stay effective longer.

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In most of the world, by population, the regulatory structure of society is so weak that there is no way to achieve this. Antibiotics are available without prescription, licensed doctors of skill are rare, and patients are insistent on antibiotics for everything. In most developed countries doctors are already parsimonious with antibiotics and generally won’t prescribe them unless an infection is observable. But in most of the developing world it’s prevalent to over administer antibiotics either through clinics are directly at the unregulated pharmacies.

> In most developed countries doctors are already parsimonious with antibiotics and generally won’t prescribe them unless an infection is observable.

Antibiotics as 'consolation prizes' is definitely a thing.

Yeah ive seen it myself, and part of it is driven by people's demands and expectations to receive treatment when they go to a doctor. Even if they go for very minor sniffles, many people will not return to the same doctor later if they are given nothing other than what boils down to "stop being a wimp and rest for a few days because nothing I do is going to actually help." Especially when the visit itself comes at a decent cost to the patient (in the US atleast). So doctors who overprescribe medication are more profitable for their owners and have higher demand from patients and are incentivized to do so, while doctors following the science more closely will be less profitable and have lower demand.

Better education on health and healthcare would help, but certainly not come anywhere near eliminating the incentives to over prescribe versus under prescribe antibiotics and medications. Perhaps more placebo medications could help, but that has its own litany of problems in making people believe they are receiving a medication when they are not, and numerous patients might view it as being scammed even if a placebo is the best thing that could be given to them.

At least in the EU they have reduced prescriptions a lot. They don't write antibiotics prescriptions if you have bronchitis unless you have a fever or if it does not improve over a span of days. 10 years ago they would just give you a wide spectrum antibiotic.

They still suck on just taking a swab and culture.

> Stop administering them whenever anyone gets a sniffle

This hasn't been true for most of my life and it remains a serious concern.

Not to mention antibiotics often come with seriously nasty side effects of their own, so you as the patient even wanting the best outcome shouldn't even necessarily want antibiotics.

It is not an issue in the US.

It is a massive, massive issue in some very large countries.

It is still a big issue in the US even if it is more massive elsewhere plus we use it in the meat industry to the point where certain types of antibiotics cannot be used anymore.

If you look at any map of antibiotic resistance, it is quite obvious where the problem is.

Ahh yes, very fair.

The problem with a policy like this is that in practice rich people will get antibiotics whenever they (we? hn is well off enough to cont as rich for this perk) want and everyone else suffers. It will for sure also summon the racist underbelly of the US where doctors will believe white sympathetic patients when they say how long they've been sick and question everyone else. This will deal double damage if you try to enforce any kind of quota.

I can afford to go to a nice doctor who will prioritize my comfort and who will literally tell me what to say to meet the criteria but anyone with less choice will have to fight.

> I can afford to go to a nice doctor

If your doctor is giving you antibiotics for clearly viral illnesses they are doing a disservice to you, it isn’t actually nice. It’s not like I’ve ever seen some systemic withholding of antibiotics when they are clearly indicated - quite the opposite, some of the worst areas for resistance are the poorest. They aren’t without other side effects, resistance being only one.

Also you have it backwards, the racist thing to do is to just prescribe the antibiotics, since they are dirt cheap, cost me (the provider) nothing, and makes the person whose skin color I possibly don’t like get out of my office faster (if not racism, pragmatism to see too many patients). Racism alone is not necessarily the only explanation, but antibiotic over prescription/use tends to be associated with poverty.

Well run antibiotic stewardship is a conceit of the most affluent health systems.

> It will for sure also summon the racist underbelly of the US where doctors will believe white sympathetic patients when they say how long they've been sick and question everyone else.

You're trying to shoehorn an unfounded accusation of racism into a discussion about antibiotics. This sh*t is tiresome.

We're not talking about antibiotics, we're talking about policy. And any discussion of policy requires systems level thinking. I'm not accusing anyone of racism, I'm white and reasonably affluent idgaf, I genuinely believe the policy being proposed would be selfishly better for me personally.

This is the reality of medical care right now in the US what are you talking about?

https://www.hopkinsmedicine.org/news/articles/2021/06/physic...

The existing bias in the medical system along with policy that asks doctors to doubt more patients has a pretty damn predictable outcome.

That isn't true at all.

Sure, but on a global scale the rich are a small percentage of the world population.

Some countries are very restrictive on prescribing antibiotics (almost too strict) and it feels like it falls flat as you can get it over the counter in a lot of places.

In Switzerland it's tough to get antibiotics unless you absolutely need them. Even when I had a lung issue for 2 weeks I had to beg to get antibiotics. Weird. And they are not available over the counter.

In Hungary, on the other hand, they hand them out like candies.

So yes, the solution was to import them from Hungary. :-)

> get antibiotics unless you absolutely need them.

Yes that’s exactly how it should be. They are not at all benign misprescribed.

> Even when I had a lung issue for 2 weeks I had to beg to get antibiotics.

Was there any evidence of a bacterial infection or did they just give in? 2 weeks is not a long time for a viral respiratory illness either.

I find this is so frustrating to describe to patients. There really is a limited scope of appropriate outpatient antibiotic use.

they didn't give in, but I actually checked hospital internal guidelines for doctors, and it states 3 weeks.

They could have done some more tests or whatever, as it was maybe the worst lung issue I've had and I was really miserable. I knew that antibiotics would help, and they did. I sourced them myself.

You could say lucky guess, but after I complained to my health insurer about the bad doctor's visit, they covered the cost fully without any dispute, so they must have agreed with me with at least about maybe running some more tests...

If it was "only" [1] a viral disease, it should dissapear even without antibiotics after a week or two. So perhaps your body solved the problem alone, while you took antibiotics that had no effect.

This is a real posibility and is a real problem to test how useful the medicines are. So all serious studies use a control group [2] to compare the rate of spontanous healing with the rate of healing with the antibiotic.

[1] Some virus are very nasty and can kill you. People confuse the common cold andd the flu, but usualy the flu is much worse.

[2] Preferabely a preregistered double blind randomized control group, becuse there are a lot of other problem that can cause a false result.

What kind of evidence are you expecting? Many diseases are treated with antibiotics without definitive evidence via some kind of test. Often, evaluating symptoms is deemed sufficient. For example, in the case of Erysipelas, an infection of the skin

The commenter did not expound on any specific evidence that would suggest a bacterial lung infection. 2 weeks of malaise and non specific upper respiratory symptoms is not strong evidence of a bacterial pneumonia, sorry.

For external infections, observation by visible inspection is still evidence, a sign, not a symptom. So, not sure what your point is. Erysipelas is invariably diagnosed by signs, not symptoms. Very rarely are bacterial infections diagnosed by symptoms alone.

The difference between symptoms and signs was unclear to me. Just checked. Thanks

Congratulations. You likely did more harm to yourself than you prevented.

When you go to multiple doctors and they're in agreement it's a bad idea, the correct response likely isn't to self-medicate in your addled state.

Judging the need for antibiotics is not some kind of personality quiz, bacteria can be cultured. (I'm not sure why they don't usually do it.)

Takes time and costs money. Problematic for an already strained health care system. And as a patient I prefer to get treated immediately for my painful skin infection instead of waiting a day or so for results to arrive

> I can afford to go to a nice doctor who will prioritize my comfort

If they actually do, they'll probably not give you antibiotics, which are associated with many undesirable short and long-term health outcomes.

Taking antibiotics for mere "comfort" in the hopes they do anything is not a good idea. Even if you were absolutely sure they will help it may still not be worth it.

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