Antibiotics Question

[oldguy00]

Just wondering, what affect do antibiotics have on energy levels, etc?

[2LeftCleats]

I am not aware of any direct effects of antibiotics on energy level. The underlying infection for which the antibiotic is prescribed is often an energy sapping condition. Sometimes antibiotics can cause nausea, vomiting, diarrhea which can obviously affect energy.

[Pete Serotta]

I have not personally observed any (above the symptoms for which they are treating). In fact I usually bring a Z PAC when I go on bike trips, just in case the planes give me a carry off friend.

[batman1425]

Who exactly is giving you a prophylactic prescription for Azithromycin to take with you "just in case".

I'm sorry to flame you, but it's that kind of blind perscribing with out proper diagnosis that is leading to the development of multi drug resistant strains of bacteria. This behavior is creating bugs that we have no ability to treat.

Don't take ANY antibiotics untill AFTER you develop symptoms and antibiotic use is determined necessary by a licenced physician after confirmation with basic lab test.

[CNY rider]

Who exactly is giving you a prophylactic prescription for Azithromycin to take with you "just in case".

I'm sorry to flame you, but it's that kind of blind perscribing with out proper diagnosis that is leading to the development of multi drug resistant strains of bacteria. This behavior is creating bugs that we have no ability to treat.

Don't take ANY antibiotics untill AFTER you develop symptoms and antibiotic use is determined necessary by a licenced physician after confirmation with basic lab test.

I don't think Pete is advocating just taking the antibiotics for the heck of it.
My wife and I are physicians and we typically carry a Z-Pak with us when going on a trip where there will not be ready access to medical care........for example, a bike trip or hiking the Grand Canyon.
I also have had savvier patients who do expedition style travel ask me for something to carry with them in case they need it at a time that medical care is not available. I've never turned them down, but I do give them the caveats about risks associated with indiscriminate antibiotic use.
Does that seem fair?

[M.Sommers]

I believe there are many hits on google regarding antibiotics causing fatigue. Then you ask yourself if the actual illness isn't accountable for the fatigue?

http://www.springerlink.com/content/k608122271106316/

and scroll down:

http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1679602&pageindex=1

http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1679602&pageindex=2

[ecl2k]

"Antibiotics" is a pretty broad term and include many many drugs with very different molecular structures and long lists of adverse effects that you may or may not experience based on your body's unique response to the medication. As mentioned above, the infection you're being treated for should be causing more fatigue than the antibiotic, but you could be the one that experiences drowsiness or other side effects from the drug, you don't know until you try.

Z-pak is mainly used to treat walking pneumonia, bronchitis, sinus infections, throat infections, and ear infections (all of which are caused by bacteria). If you walk off the plane with cold symptoms then you probably have a viral infection and the Z-pak will have no effect other than promoting bacterial resistance and exposing you to the risk of some of the side effects, some of which can be severe. It's just bad medicine, and I notice that a lot of the people that live healthy lifestyles and eat organic and exercise have no problem popping drugs that their body doesn't need, I have a hard time understanding it.

[batman1425]

CNY Rider,

I agree with you that with proper knowledge and experience (i.e. 4 years of medical school and an M.D), carrying a "emergency" supply on a long trip in the wilderness is a good safe practice. However, even though you are explaining the risks of indescriminate antibiotic used to your patients, there is no way to regulate their use of these antibiotics once they leave your office. And they do not have the knowledge of medicine that you do. You are leaving it up to the patient to decide when their use is appropriate and that is the problem. This same problem is seen even when patients DO need antibiotics. Many stop taking them after they begin feeling better and do not complete the antibiotic course. This has the same effect as over perscription and is the reason why some antibiotics have to be taken in front of a witness or at a hospital to confirm the course was completed.

I'm certaintly not trying to say that if someone is stuck in the middle of the grand canyon with a septic infection that they shouldn't take the antibiotics they keep in the med kit. That scenario is the reason why it is a good idea to bring medicine at all. I'm more trying to hilight the inability for the average person to determine what is the appropriate time to resort to taking them and thus why people should not pester their doctors to give them Rx's as a back up plan.

I'm more concerned about the scenario of:
I woke up this morning not feeling so good, and I'm here in spain for this bike trip I've been planning all year, so I'm just going to take these and hope I get better.
In this case the caused could be bacterial or viral. In which case the antibiotics would be totally ineffective agains a viral infection and may or may not work on a bacterial infection, depending on what kind of bug it is and what the antibiotic is. In this case it is more likely that the outcome will be a patient that doesn't get better any faster and activly contributes to the development of antibiotic resistant pathogens.

I would also wager that this scenario is far more common than the person with a septic infection in the middle of the grand canyon.

Letting the patient be the doctor creates a situation where no one is held responsable for the use of the drugs and I feel that will create more problems in the long run. If we are going to let the patients decide when the antibiotics are necessary, then why not sell them over the counter? If that sounds crazy, then so should handing out Azithromycin "just in case" because thats effectivly the same thing.

Just my opinion. Not meant to attack anyone personally or specifically.

[malcolm]

Batman, what is the basic confirmatory test? Unless I've missed some major breakthrough that one doesn't exist. The viral vs bacterial decision is clinical the overwhelming majority of the time and honestly is usually viral.
I usually always take antibiotics as well as corticosteroids with me when I travel as well. A does or two of prednisone has saved many a trip. Another good thing to bring especially in travel to tropical climes is an abx/steroid ear drop combo in case of swimmers ear/otitis externa.

[regularguy412]

I routinely use Neosporin as a prophylactic against saddle sores. The petroleum base works well to lubricate surfaces and help avoid chafing. The antibiotics in the salve kill any opportunistic nasties that might want to infect raw skin. I'm sure that the antibiotics in the salve are going into my system to a certain degree, and not just working on the skin's surface. I wouldn't think that the antibiotics involved in topical applications would affect one the same as those in a prescribed antibiotic. I've not noticed any negative effects in this type of antibiotic application.

Mike in AR:beer:

[malcolm]

regularguy, the only real negative I know of with neopsorin is a large number of people are allergic to it to some degree and will develop redness and even a little weeping, particularly on open or abraded skin, thus it makes it difficult to know if a wound is becoming infected. Many ED/hospitals use ointments without neomycin because of this.

[batman1425]

A combination of medical knowledge as well as a white cell count, strep culture, blood cultures, Mono test, etc. can ID or eliminate most of the major contenders for general illness. All these tests are basic and routine. If more precise determinants are needed there are molecular diagnostic test that are also available.

I never said you could defferentiate between viral and bacterial that easily, but these above mentioned BASIC tests can determine if antibiotics are necessary when combined with a doctors general medical knowledge and the presenting symptoms.

Which furthers shows that unless the patient posesses the knowledge from the above tests and general medical education, they should not be self determining their need for antibiotics.

[batman1425]

regularguy and Malcom,

If alergies to neomycin are a problem, I believe there are some over the counter antibiotic creams that contain bacitracin as an alternative.

[goonster]

I need a half pound of amphetamines for my upcoming solo circumnavigation. Just in case I have to bail the bilge nonstop by hand with a soup pot for two weeks. You may lecture me for a half hour on the "risks".

Help a brother out! :beer:

[WadePatton]

While I generally _refuse_ medical attention and let the body work things out, I was flattened by a fever a couple of weeks ago. High fever, blinding headache, aches--I dragged myself to the doc the next day when the fever let up a tad. He prescribed antibiotics as the only clue we had to my condition was that I had had some tick bites (that's a normal thing). FOUR more days of evening fever/chills but never as bad as the first and I was symptom free. Then the bloodwork comes back positive for Rocky Mountain Spotted Fever. I finished the course of pills.

My point. Anti-biotics (don't recall the name) worked great in this application and I've allowed myself some time to get over the imbalances created by the fever and the drugs before I get back on the bike. Now it's hooooooooot without a fever. :D

I understand that a viral thing would have been different.

[malcolm]

batman, none of the tests rule out or in bacterial infection. WBC is of little use, bacterial infection is usually associated with an elevation however it is not reliable enough to make a decision, other organisms also cause pharyngitis. I'm not disputing the fact that they can provide helpful info but the decision is ultimately clinical. Molecular testing and PCR is only helpful after the fact and you will be either better or dead if you wait on it. We do a horrible job of prescribing abx, but trust me it isn't from lack of unnecessary testing, it is primarily consumer driven and from the fear of missed dx.. In the private world if you don't prescribe your patient goes somewhere else in a couple of days and gets abx and low and behold feels better the next day. Well you and I know it was just the virus running its course but the pt is convinced it was the abx and you just lost a patient. Not saying I believe or agree with this just saying I see it everyday.

[goonster]

Wait a minute . . .

Are the disciples of Hippocrates here suggesting that while there are tests that can determine whether a dude put a t-patch on his nads for one night, or transfused somebody else's blood in the pursuit of a medal, there is no reliable test to determine whether an infection is viral or bacterial? Something about which potentially life or death medical decisions are made every day for millions of people? You have to look at the overall picture of history and presenting symptoms and then make a judgement call based on your training and experience?

I'm shocked. Shocked!

[CNY rider]

Wait a minute . . .

Are the disciples of Hippocrates here suggesting that while there are tests that can determine whether a dude put a t-patch on his nads for one night, or transfused somebody else's blood in the pursuit of a medal, there is no reliable test to determine whether an infection is viral or bacterial? Something about which potentially life or death medical decisions are made every day for millions of people? You have to look at the overall picture of history and presenting symptoms and then make a judgement call based on your training and experience?

I'm shocked. Shocked!


I'd explain how much of treating cancer in an individual patient is a series of judgment calls, not textbook based, but it might leave you incoherent! :eek:

[batman1425]

Malcom-

I agree with what you are saying and that there are big problems in the ways that antibiotics are doled out. But this was not in reference to un necessary testing or lack there of. I'm talking about some of the first comments in the thread, where people were obtaining antibiotics BEFORE getting sick. Thats what I mean about needing a proper diagnosis. People going to the doctor to get antibiotics in case they get sick is the issue that is being presented.

I also mentioned in the previous post that the tests won't tell you everything, but when combined with the presenting symptons (including duration) and the general medical knowledge of the attending, a good guess as to the effectivness of antibiotics can be made and whether or not they should be perscribed.

All of this doesn't change the fact that the patient shouldn't be given the option to make that decision and by giving out antibiotics before any illness has been presented is doing just that.

[vaxn8r]

The irony is Zithromax has almost zero effectiveness for many bacterial illness today. It's one of the easiest and first antibiotics for organisms to develop resistance. It has no penetration into the sinuses. Little into the middle ear space, poor coverage on strep, misses most bacterial pnuemonia, doesn't cover skin infection, abcess or even sepsis in the grand canyon.

At least it's still good for Chlamydia and cat scratch disease though. It can treat traveler's diarhea as well but is only indicated for bloody stool with >4 per day.

When I hear a parent tell me their doctor gave them Zithromax, my first thought is I bet he/she didn't think you had a bacterial illness. Easier to give a Z pak and let them heal on their own than to spend 10 minutes explaining why they don't need an antibiotic and have them go away mad.

[malcolm]

Vax,+ 10000000000000........

[batman1425]

So I guess your saying it's better for doctors to do what's easy than what's right.

I'm glad my doctor doesn't think like that

[malcolm]

Medicine is an art and I don't think you know me well enough to comment on my abilities or qualifications. I don't agree with it but I understand it. I don't think much of what we do right or wrong is easy. I agree with you fully about abx use, howver I was trying to provide some real world insight as to why things are the way they are and why it is unlikely to change anytime soon. I'll even give an example, say I see a child at 2am it the ED and I don't prescribe abx because I don't think they need it. Well mom is mad and I'm unable to convince her that they are unwarranted in the few minutes I have to spend in my 52 bed emergency dept.. Well mom fills out a pt satisfaction survery unfavorably and now my groups stipend from the hospital is nonexistant and a group of residency trained emergency physicians are looking elsewhere for work and some knuclehead with a license is filling my spot. Making pts happy has become priorty one and often to their own detriment. So see it is never as simple as your doctor doing the right thing, maybe one day but today with econmics and legal pressures not so much.

[vaxn8r]

You think it's bad now? What happens when Walmart opens their health clinics? My guess is the amount of Rx's written is going to quadruple. There is only one reason for Walmart to have clinics and that's to fuel the pharmacy.

Malcom is on the front lines. He gets it. We're only scratching the surface here. It is not a black and white issue by any stretch.

[M.Sommers]

Big Pharma.
It's profit per-dollar makes Big Oil sales look like a joke.
True.

[Pete Serotta]

I take responsibility for my own actions. (as we all should. The choice I made was mine))


I have only used the X once and it worked or I just got better - Either way it does not matter to me which.

I carry the Z Pak for just the reason mentioned. Luckily I have only had to use one in three years. Usually I do not catch something BUT being in the CANYON LANDS Park or overseas- I feel better having it even if I do not use. I do not like drugs and if antibiotics of any type are used it is under a doctor's guidance - unless I am in no man land. :)


I don't think Pete is advocating just taking the antibiotics for the heck of it.
My wife and I are physicians and we typically carry a Z-Pak with us when going on a trip where there will not be ready access to medical care........for example, a bike trip or hiking the Grand Canyon.
I also have had savvier patients who do expedition style travel ask me for something to carry with them in case they need it at a time that medical care is not available. I've never turned them down, but I do give them the caveats about risks associated with indiscriminate antibiotic use.
Does that seem fair?

[vaxn8r]

But Pete, with a Z-Pak the chances of it covering "whatever" is slim to none. It used to be considered a broad spectrum antibiotic. Now it covers almost nothing. I doubt your Z-Pak made you better. If I was going to travel to the hinterlands I'd rather carry a flouroquinalone, Septra or even clindamycin. Even then, there is no one antibiotic that works on pretty much everything. Not even close. So the whole idea of having something preventively just in case, is faulty logic. You might as well wear a tiki necklace and rub it 3 times when you get a headache.