Is there a doctor in the house?!

[NuWaveRx]

[quote][i]Originally posted by phillyidol[/i]
<br>OK, so when do you need anti biotics? To be honest, I never used them till I was 18 years old.
[/quote]


Here are the key recommendations from the American Academy of Family Physicians:

1. A diagnosis of acute bacterial rhinosinusitis should be considered in patients with symptoms of a viral upper respiratory infection that have not improved after 10 days or that worsen after five to seven days.

2. Treatment of sinus infection with antibiotics in the first week of symptoms is not recommended.

3. acute bronchitis in otherwise healthy adults should not be treated with antibiotics.

The American College of Physicians position paper on this subject also states:

1. The diagnosis of nonspecific upper respiratory tract infection or acute rhinopharyngitis should be used to denote an acute infection that is typically viral in origin and in which sinus, pharyngeal, and lower airway symptoms, although frequently present, are not prominent.

2. Antibiotic treatment of adults with nonspecific upper respiratory tract infection does not enhance illness resolution and is not recommended. Studies specifically testing the impact of antibiotic treatment on complications of nonspecific upper respiratory tract infections have not been performed in adults. Life-threatening complications of upper respiratory tract infection are rare.

3. Purulent secretions from the nares or throat (commonly observed in patients with uncomplicated upper respiratory tract infection) predict neither bacterial infection nor benefit from antibiotic treatment.

Unfortunately none of the above makes a patient feel better when a cold/flu is really knocking them on their ass. Your symptoms may be predominantly pharyngeal so antibiotics may be indicated. In general, most of the internists I work with use the 7 day rule--URI symptoms for 7+ days gets antibiotics. Lower respiratory symptoms, a high fever or other markers may dictate earlier treatment. Again, I hope you feel better soon.

References:

Am Fam Physician. 2006 Sep 15;74(6):956-66.
Ann Intern Med. 2001 Mar 20;134(6):490-4.

[phillyidol]

Wow thanks for all the info. I think I better go to see the doc today. I'm past 7 days and the sore throat is getting unbearable. Thanks!

[WolverineSyr]

Perhaps it's just sore from all that screaming you've been doing lately. "A Sale at Macys!!!!! I'm There!" "Christmas Cookies? Git Outta My Way Old Woman!" "Santa why have you forsaken me! I want PLEATHER!"

[phillyidol]

LOL!!!!

[BigBri]

[quote][i]Originally posted by NuWaveRx[/i]
<br>[quote][i]Originally posted by phillyidol[/i]
<br>OK, so when do you need anti biotics? To be honest, I never used them till I was 18 years old.
[/quote]


Here are the key recommendations from the American Academy of Family Physicians:

*snip*

[/quote]

That's all well and good, but chances are, Philly, you'll go home from your doctor's office with an Rx in hand, perhaps justifiably so. He may or may not bother to swab your throat for strep, which is a less likely diagnosis if you have cold symptoms (like sneezing, runny / stuffy nose...), but confirmation of strep would at least allow him to prescribe a more appropriate antibiotic to specifically target it.

We pediatricians are probably more judicious when it comes to prescribing antibiotics than adult med MDs, as our medication choices are much more limited, and so the consequences of inducing resistance are greater. Internists, in my experience, are more liberal with this, but there could be good reasons for this: adults tend to let their illnesses fester longer before seeking help; adult medical histories can be often be complex, warranting a more aggressive approach; smokers/ex-smokers with upper respiratory infections probably have a greater incidence of complications; etc.

[phillyidol]

You guys are teaching me alot here. I got back from the doc and you were all right. No strep. He did give me a prescription for anti biotics but said only use it if the symptoms change. For now, just keep with the over the counter stuff, gargle, nose spray, and cold ease. He said the zink really does work. Thanks guys. DEVO!
Oh I really do thank you because I am a total hypo ...whatever. I think I have everything. So I do feel more at ease with the advice.

[NuWaveRx]

I must confess I don't see the point you are trying to make here BigBri...Philly asked when it was appropriate to treat adults with URI symptoms with antibiotics. I responded with the guidelines of two of the largest primary care organizations regarding this topic. Guidelines endorsed by CDC and several other health care groups. If your point was that the majority of primary clinicans do not follow these guidelines I agree. Not only from my experince, but validated by a large survey of primary care clinicians (JAMA 1997; 278:901-4). I'm glad you and your pediatric colleagues use antibiotics judiciously (although, it appears that a study in Pediatrics suggests the problem is still serious in your speciality--about 35% of staff pediatricians prescribed antibiotics for probable viral infections in a large survey (Pediatrics 2005; 115:635-41)). Overuse of antibitoics in all populations appears to be a significant problem. Considering the risk of increasing resistance and the sharp increase in Clostridium difficile disease its a problem that patients, physicians, and all health care professionals need to address.

And philly, I'm sorry to say that, unfortunately, Zinc does not have strong evidence to support its use in decreasing the severity or length of common cold symptoms. Numerous studies have had conflicting results and two meta-analyses (a way to combine and examine the results of multiple studies--but I defer to the Stats deity here at NWO (Blir) to explain more fully) concluded that Zinc is not effective for the common cold (Arch Intern Med. 1997;157:2373-6, J Nutr. 2000;130:1512-5.)

[phillyidol]

I am loving all this advice! I need it. Ok one more question: I have developed a really sore throat. He tested and its not strep but its bad. He suggested the zink for the throat. weather it works or not...we will see I guess. But it is killing me. I can't stand it. But he did say that my sore throat is viral so antibiotics would not help. Any suggestions and how long does it last? BTW I think I owe you guys a drink.

[DSR]

[quote][i]Originally posted by NuWaveRx[/i]
<br> Overuse of antibitoics in all populations appears to be a significant problem. Considering the risk of increasing resistance.

[/quote]

This has also been the problem in our practice here. People tend to self-medicate themselves whenever they feel sick. Resistance to antibiotics definitely occurs in such degree. I agree with NWRx about some physicians not following the guidelines since some of them get it from experience through the years of training and practice. Amoxicillin is one drug that is usually abused.

[:)]An apple a day keeps the doctor away!
DR. STIRRING RHOD

[BigBri]

[quote][i]Originally posted by NuWaveRx[/i]
<br> If your point was that the majority of primary clinicans do not follow these guidelines I agree. Not only from my experince, but validated by a large survey of primary care clinicians (JAMA 1997; 278:901-4).
[/quote]

You hit the nail on the head.

Yes, we're not perfect in pediatrics, either. I do know of some colleagues who dish out antibiotics like water. And I know I've been guilty of it, too, against my better judgement. But I do feel that most pediatricians who have at least done their training around the same time as I are stricter about it.

A little patient education always goes a long way in that regard.

DSR:
My mother-in-law is one of those "self-medicators." Several years ago my wife and I came across a closet in her home containing old hoarded medications, included many different antibiotics. Among them was tetracycline, no less.

But who was I to say anything? She is the mother-in-law, after all...

[NuWaveRx]

[quote][i]Originally posted by BigBri[/i]
A little patient education always goes a long way in that regard.

DSR:
My mother-in-law is one of those "self-medicators." Several years ago my wife and I came across a closet in her home containing old hoarded medications, included many different antibiotics. Among them was tetracycline, no less.

But who was I to say anything? She is the mother-in-law, after all...

[/quote]

Well that's one way to take care of your mom-in-law[:o)]

I agree patient and public education is very important--I'll pass on antibiotics now if I know my docs can use them when I'm very ill in the hospital.

DSR you practice in the Phillipines? Are any antibiotics available without prescription there? I know that in some European countries the easy availability of these drugs has led to some very resistant organisms--especially S. pneumo.

Phil, the sad fact is that most over-the-counter products for cold symptoms either don't work very well or at all (unless you're trying to make crystal meth[:p]). My recommendation is scheduled ibuprofen (again, assuming you don't have any major stomach ulcer or kidney problems), cepacol or chloraseptic lozenges/spray and tea w/honey. Here's hoping by x-mas you feel much better.

[DSR]

[quote][i]Originally posted by BigBri[/i]
<br>

DSR:
My mother-in-law is one of those "self-medicators." Several years ago my wife and I came across a closet in her home containing old hoarded medications, included many different antibiotics. Among them was tetracycline, no less.

But who was I to say anything? She is the mother-in-law, after all...

[/quote]

I understand BigBri, there are really lots of hardheaded patients that I've encountered that feel like they know better than us Physicians. Regarding the use of antibiotics, well, I guess everyone of us in one time or the other would be guilty of such practice especially if we are atill on the process of identifying the etiology.

[:)]An apple a day keeps the doctor away!
DSR

[DSR]

[quote][i]Originally posted by NuWaveRx[/i]
<br>

DSR you practice in the Phillipines? Are any antibiotics available without prescription there? I know that in some European countries the easy availability of these drugs has led to some very resistant organisms--especially S. pneumo.

[/quote]

Antibiotics here is by Prescription, but sadly there are some drugstores who are not following this, thus making Amoxicillin less potent drug thus resistance becoming a problem.

[:)]An apple a day keeps the doctor away!
DSR

[phillyidol]

Hey thanks for all the help and advice guys!
Check this out. I talked to a guy from Guyana. He said he loves antibiotics. He said where he lived, you can buy them by the bottle. He said yes he loves them and you just take them whenever you are sick, and you get better. THIS is a nightmare. If people actually believe this and over use like crazy, we are in trouble.

[hexicon]

Yikes, no kidding, Philly.

I've had mild acne breakouts my entire adult life. The HMO to which I belonged in the 90s did not want to fork out the $$ for Retin-A (a topical anti-acne medicine that works by drying the skin and making the skin cells turn over more quickly). Nooo! Instead they put me on broad-spectrum antibiotics for YEARS. I hate to think what kind of immune bugs that practice caused to develop.