Obtaining Antibiotics without a Prescription (2002)
nejm.org
nejm.org
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
(2)http://switchboard.nrdc.org/blogs/slyutse/resistance%20graph...
(3)http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm378100.ht...
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.
But overuse of antibiotics for things like ear infections is also part of the problem too.
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.
"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?
For that matter, the current strain of C. difficile which is causing so many problems was first observed in the UK and Canada.
Antibiotics are a balancing game of just the right dose. I suppose vet medicine is better than nothing at all in dire straights but if its at all possible, see a people doctor. They're good at that sort of thing.
I think he should have right to bet on it. Most times he will win.
I think that most limitations on sale of medications are bad for people and should be lifted.
I'm also not so sure that people doctors are so good.
I fail to understand how commanding people what to do with their own body is suddently okay when it comes to medicine.
All that being said, I think it is a shame that we live in a system where it is so expensive and inconvenient to see a real doctor that people resort to this kind of thing.
Gram stain, because it's very fast (minutes) and can tell you, e.g., that you have Gram positive cocci in clusters (thus, likely staphylococcus species).
Culture, then, to grow the bugs and see what nutritional requirements they have and what biochemical modifications they make. Catalase producing? Likely staph aureus.
Finally, sensitivities: resistant to oxacillin? MRSA.
One could imagine PCR-based tests, too, though at my institution such a test is not in use.
Getting back to my question, how did you successfully self-diagnose MRSA?
So the MRSA diagnosis is hard to swallow, but getting to staph aureus might be doable.
It's still unlikely, though, firstly because PCR is hard, and secondly, because what person willing to go to that much effort wouldn't just go to the doctor?
1. Intense pain that extends beyond the boundaries of the visible irritation. Pain that is much more intense than a normal pimple or ingrown hair.
2. Distinct rash (as far as I understand the rash is caused by the specific toxins MRSA generates)
3. Necrosis of the skin. MRSA will produce blackened dead skin which many people mistake for a scab.
That, and I had MRSA years ago and had it diagnosed by a doctor, so I was already familiar with the condition.
If you have pain way out of proportion and darkening skin (or any rash for that matter), that's not the time to play House. Call your doctor if you have one, or just go directly to the ER.
The primary distinguishing feature of MRSA vs regular staph aureus ("MSSA") is MRSA's resistance to oxacillin/methicillin. While you can find research papers distinguishing MRSA from MSSA on clinical grounds, I'm not familiar with any clinical distinguishing feature that is used in practice (aside from sensitivity analysis or PCR, which are laboratory techniques, not clinical ones).
This is exactly the problem with people self treating. Without a proper workup, which in this case would have likely involved some sort of diagnostic microbiology, people end up over- or mistreating themselves.
I also think it's a pretty good idea to carry emergency medication when traveling abroad. You won't know where medical care will be available, and indeed how to avail yourself of that care. Having a Z-pack and a couple of other things handy can save a lot of trouble. This has been a big boon to me more than once in the past. One one occasion the wife got a UTI, which is easily treatable with the right meds. On another occasion I helped out a fellow traveler, a doctor as it happens, by giving him an Ace bandage for a sprained ankle.
I actually have some fish meds stored in case of emergency, but have never been desperate enough to use them. The extra stuff I have on hand I acquired while traveling abroad, in countries that have looser restrictions on pharmaceuticals (this used to be Mexico, but they recently tightened up their laws).
Some people are imprisoned for the anti anxiety pill in their bllodstream that they took before the flight.
Carrying prescription medications with unclear prescriptions is risky advice unless you're sure about the country you're travelling to.
OMG, where? I need to be sure to never go there, given my random (being treated) phobias and such.
http://wikitravel.org/en/United_Arab_Emirates has some relevant info.
A woman was arrested for some passport/visa irregularity and they then took a urine sample and found Codeine and Temazepam in it, which she had been given by a doctor in the UK. They gave her a four year sentence, but she was eventually acquitted, after two months.
Harsh.
I hope it never gets to the point where I can get in trouble for my motion sickness pills.
Really? Which countries are now demanding blood samples at the border?
Also no regulation as to how they are used. Super-bugs are being bred by over-use, and a careless or ignorant individual can make his/her own infection hard to kill by using antibiotics in other than the approved way (e.g. not finishing the course).
Self medication is possible and, with enough research, can be done successfully and responsibly, but for most people it's really not a good idea.
If you really want to get right down to it, why are guys in special forces (arguably reasonably smart, also evidenced by their figuring out this antibiotics trick) NOT going to see an army doc right away?
If I was going to be a really snarky asshole I might suggest that perhaps because it's a single-payer system the quality of care isn't that great and blah blah blah. I don't really believe that but arguments can be made both ways.
Don't be a troll.
More generally, what makes sense for your career sometimes negatively affects other areas, but we tend to protect our careers.
Are there antibiotics that keep well and are good for general infections? (Purely as a last resort if there's no way for them to get medical attention)
I suspect antibiotics in livestock/food supply are an even greater contributor to resistance, because they are used as preventative medicine in that sector, but really, neither is good.
Or have I forgotten something.
Has anything changed?
The efficacy of those antibiotics, I'd wager.
Unfortunately, I told my mom about fishmox a long time ago (during same salad days) and now I sort of wish I hadn't. It's her standby plan and I'm not likely to be able to convince her otherwise.
This seems to imply an assumption that all bacteria are resistant, when it's my understanding that this is actually a small [in relative terms] but growing phenomenon.
I probably could have phrased it better. Blame lack of coffee.
http://www.washingtonpost.com/blogs/wonkblog/files/2014/01/a...
Almost four years later, I'm trying to get a pilot license for recreational purposes and now I have to admit to having had a mental disorder, get written statements from all providers, and go through special review from the FAA. I can't imagine what a special ops guy or airline pilot would go through.
That's not even mentioning the hell I went through for pre-existing conditions as a result of this prior to the ACA.
There are very strong disincentives to seek treatment.
http://www.walmart.com/cp/PI-4-Prescriptions/1078664
Lots of other places have similar programs/prices.
So the expensive part is getting the prescription.
Amazon: http://www.amazon.com/Biseptol-Co-Trimoxazole-20-tabs/dp/B00...
Wiki: https://en.wikipedia.org/wiki/Trimethoprim/sulfamethoxazole
Where is the news?
We cannot have the profits of our Most Holy Corporations drop. Cheap antibiotics will cause a drop in the Most Holy Profits of Our Sacred Corporations, and That Is Not Permissible.
How much profit is made by the misuse of antibiotics in animal rearing?
The opposite is true: with bacteria resistant to ancient antibiotics that are out of patent and work in weeks, the only alternative will be treatment for months or years with heavily patented drugs of dubious effectiveness and long hospital stays.
Is that your preferred outcome?
People, as a whole and on average, are terrible at judging long-term costs and overuse.
Now, if the product was priced to properly reflect negative externalities of use and abuse, maybe. But, that's not going to happen.
Because, you know, people are idiots and you know better.
So make them consult a well-paid and often clueless bureocrat before buying anything listed above. No prescription - no bottle.
The harms from antibiotic overuse don't go to the people doing the overusing.
You can try to limit animal antibiotics use but that industry can fight back.
People, you persuade. Nobody have to preserve your commons for you. If you want that field be green, what are you willing to spend?