No running on Cipro? (Read 1548 times)

That amox has fallen off has nothing to do with the actual pathophysiology or microbiology of infections.  It has to do with the same phenomenon you quoted, that patients have become more and more empowered over recent years and tend to want the latest and greatest, not tired old amoxicillin.  There is resistance out there to loads of antibiotics and cipro induces resistance far more easily than amoxicillin, but it is flashier (more badass) and so folks tend to poo poo their docs when offered amoxicillin.  Ennay is an exception.

And given the current healthcare system, most docs will get paid to see you back the following week after a failed course of treatment, and that is usually an easy visit since the doc knows the patient and the case already => easy RVUs.

I wouldn't go so far as to call the brother stinky.  But he definitely got a fart problem.

 But what's a brother gonna do? He's on  'Cillin.

Globbie is a good argument for this bill.

 Wow, that sounds like something out of a science-fiction book... and yet... wow.  Yeah, I guess someone's going to try sooner or later...

For a UTI in adults, amoxicillin is not a good choice because it does not generally cover the infecting organisms.  The organisms that generally cause adult UTIs, the drugs that are typically reasonable first line are sulfa, nitrofurantoin and cipro. 

UTI ≠ ear infection

Um, the organism that usually causes UTI is not covered at all by the class of drugs that cephalexin belongs to; I don't understand your treatment at all

Ha.  Funny.  Nope, doctors are the last ones to get kickbacks and HMOs have pretty poor penetration in my practice.  Amox is the best drug for MOST people with ear infections.  And the recommendations come from CDC and WHO, among many others, not from HMOs.  To be clear, most expert organizations don't get on well with most HMOs.

In the case of YOUR child, amox does not work because YOUR child is colonized, apparently, with bacteria that are resistant to amoxicillin.  How did your kid's bugs get resistant, you may ask?  Well, they got resistant because of the general overuse of the wrong antibiotics in the world, much as bugs are increasingly getting resistant to Cipro.  The more we prescribe and the more "badass" antibiotics we use, the more resistance comes up.  And about your child, understand that we don't treat patients based on experience with a single anecdote (at least we should not), but based on what science tells us about the population.  If we happen to know something about an individual child (for example, that YOUR child tends not to respond when given amox) then we can customize therapy.

FYI, augmentin = amoxicillin with a single additive that renders the amoxicillin a bit stronger in the presence of a particular bacterial resistance factor.  That additive is called clavulonic acid.  Calvulonic acid has NO ANTIMICROBIAL activity, but simply competes at a molecular level with that resistance factor so that the amoxicillin in the augmentin can do its job.

AND pediatric dosing for different drugs is highly variable.  Some pediatric drugs like amoxicillin occasionally require adult doses while others do not.  That has little to do with them being "so bad", and more to do with the amount required to achieve a therapeutic effect.  In particular, amoxicillin is give at a dose of 90-120 mg/kg/day up to the normal adult dose of 500 mg three times daily or 875 mg twice daily.  If you do the math, a 30 lb child will get the adult dose.  That does not mean the drug is weak (since that same dose works in big fat adults too), but only that it takes that particular dose.

And yeah, perhaps with cheaper drugs tthe HMO saves money, the medical system saves money, society saves money.  The same is true whenever less expensive testing and treatments are employed, when redundancy is eliminated.  Where do you think all that money comes from?  It comes from your employer and your government.  The higher the cost of healthcare, the more stuff costs in stores and the higher our taxes have to be to cover it.

Let me put it this way: I would almost never prescribe keflex for UTIs in otherwise healthy adults unless I knew that they were at risk for urinary infections with they type of organism that responds to it (this is the part about customizing the general treatment for the individual's particular needs).

Theresa, docs are humans and medicine is very complex AND it is very hard to keep track of individual patients, even with good medical records.  The high pace that most healthcare providers have to keep when seeing patients (I saw 28 yesterday, 27 on Saturday) makes it very hard to be able to take the time to gather all the necessary information.  This is why empowered and educated patients are a good thing.  Nobody cares more about their health then themselves, and with the correct information, patient can do a lot to help themselves. The challenge for patients is that there is a lot of incorrect information out there and it sometimes takes a lot of work to synthesize the new concepts.  So with good information, patients should also empower themselves with an open mind and good questions.  Don't go to the doctor expecting the doc to get everything right or wrong, but rather look at the doctor as a trained consultant who will help guide you to health using the information that they know and the information that you bring.

Medical records are very challenging when it comes to finding out information previously recorded, such as a patient's drug allergies.  This is one reason why electronic medical records are touted as a way to improve care.  Of course, some electronic medical records are just as convoluted to use as thick paper-based charts.

Let me put it this way: I would almost never prescribe keflex for UTIs in otherwise healthy adults unless I knew that they were at risk for urinary infections with they type of organism that responds to it (this is the part about customizing the general treatment for the individual's particular needs).

 

Theresa, docs are humans and medicine is very complex AND it is very hard to keep track of individual patients, even with good medical records.  The high pace that most healthcare providers have to keep when seeing patients (I saw 28 yesterday, 27 on Saturday) makes it very hard to be able to take the time to gather all the necessary information.  This is why empowered and educated patients are a good thing.  Nobody cares more about their health then themselves, and with the correct information, patient can do a lot to help themselves. The challenge for patients is that there is a lot of incorrect information out there and it sometimes takes a lot of work to synthesize the new concepts.  So with good information, patients should also empower themselves with an open mind and good questions.  Don't go to the doctor expecting the doc to get everything right or wrong, but rather look at the doctor as a trained consultant who will help guide you to health using the information that they know and the information that you bring.

 

Medical records are very challenging when it comes to finding out information previously recorded, such as a patient's drug allergies.  This is one reason why electronic medical records are touted as a way to improve care.  Of course, some electronic medical records are just as convoluted to use as thick paper-based charts.

 +1

I am a firm believer that docs and patients have to work together. If you can get yourself educated on your condition then you start to know what options are out there for you.  Then you can work together with your doc to find the right one.  And you can come to the appointment with more pertinent information that will help the doc to do her job too. 

I do advocate the use of on-line health information (because that's my job ) but "everything in moderation". Don't demand the newest drug on the market because it is not always the right one for you and I'd rather take good ol' amoxicillin any day since at least we know it's safe since it's been tried on a billion or so people & kids.