Possible move into playoff position - Jazz at Grizzlies - 3/9/2018 6:00 pm MST

[Deleted member 848]

It's not really an individual using them too much, it's thousands of individuals being prescribed them and all of them taking 1/3 to 1/2 the amount that was prescribed because they started feeling better or just forgot.

If you use antibiotics you want to kill all the bacteria you're trying to kill. If you kill 80-90% of it the bacteria leftover are the ones that are more resistant to that antibiotic, and so if that heartier segment of the bacterial infection spreads it become more difficult to treat with antibiotics.

overuse is a huge, huge problem-- everytime you use antibiotics, you are selecting for resistant bacteria that can now colonize the "real estate" leftover from the now-dead bacteria. This is actually a pretty big thing-- one of the best ways our body stops things like brutal ecoli infections from giving us the runs is just from our gut being lined with healthy bacteria, and not providing any decent real estate for the bacteria to lodge themselves in, and start growing. Unfortunately, antibiotics are rarely specific-- even something as narrow-spec as amoxicillin (beta-lactamase) will destroy all kinds of beneficial bacteria.

Many of the superbugs we now currently have are due to overuse of antibiotics in the healthcare, and agricultural spheres. Even our broad-spec bazookas like carbapenems are now useless against certain types of Enterococcus bacteria because farmers in China have used the drug to feed their chickens.

It's a mess. Antiobiotic-resistant bacterial infections are going to cause incredible public harm towards the end of the 21st century-- some say it'll kill more than cancer.

--

You are correct in that patients are supposed to complete their course of antibiotics as specified by the pharmacist or the physician-- if you don't, there is chance that a resistant bacteria will grow and re-infect you. Correct on that point, Gameface.

 

[Deleted member 848]

You paid a share your doctor's insurance premium in case you are deathly allergic to amoxicillin, you die, then your wife sues his practice for millions. (My daughter is deathly allergic to amoxicillin, doctor caught it really early, she didn't die.)

If they screw up your medical care in Canada, you can sue the system for all its worth, right?

In Canada you sue the college of physicians. Unfortunately, in America, because of the fear of litigation, physicians waste all kinds of money on useless tests in order to minimize their error rates (to no avail-- error rates in the United States are equal at best to those in Canada, generally worse). Another reason why Americans spend more per capita on health care, even though they then get ******** healthcare.

 

[Deleted member 848]

Underconsumption is the problem.

My issue with this hypothesis is purely statistical. It's not thousands of people it's several billions. By those numbers, super bugs are going to form amoxicillin restance regardless of a doctor prescribing an antibiotic or not.

We could have a system where you are educated by the pharmacy that you must take the entire duration even if you feel better for certain infections like strep throat. Super bugs aren't going to form any faster in overuse situations since we all have an immune system.

Maybe Dr. Dala can correct me on this if I'm wrong.

Generally speaking, the prescription of amoxicillin for something like strep throat is actually medically completely unnecessary for that specific strep throat infection.

The only reason physicians in North America (in Germany, they simply don't prescribe Amox for strep throat-- avoid the generation of superbugs as you've implied) prescribe amox for something like a strep throat is out of fear for something called Rheumatic Fever. Basically, there is a one in several thousands chance that if you sustain strep throat infections repeatedly over the course of a lifetime, it can generate an auto-immune response in your body where the valves in your heart are 'attacked', in a sense. Causes stenosis (narrowing) of the various valves of the heart, particularly the mitral valve. This stenosis can sometimes further develop into something called mitral regurgitation-- meaning your blood actually is pumping backwards, not forwards (uh-oh). Generally this will result in heart failure unless you quickly replace the valves.

So yeah, it's a small risk, but it's a pretty disastrous consequence in case it formulates. The reason we rarely see rheumatic fever in north America is because of how quickly strep throat infections are genuinely addressed-- but again, other nations think that the risk doesn't justify the prescription.

 

[franklin]

Generally speaking, the prescription of amoxicillin for something like strep throat is actually medically completely unnecessary for that specific strep throat infection.

The only reason physicians in North America (in Germany, they simply don't prescribe Amox for strep throat-- avoid the generation of superbugs as you've implied) prescribe amox for something like a strep throat is out of fear for something called Rheumatic Fever. Basically, there is a one in several thousands chance that if you sustain strep throat infections repeatedly over the course of a lifetime, it can generate an auto-immune response in your body where the valves in your heart are 'attacked', in a sense. Causes stenosis (narrowing) of the various valves of the heart, particularly the mitral valve. This stenosis can sometimes further develop into something called mitral regurgitation-- meaning your blood actually is pumping backwards, not forwards (uh-oh). Generally this will result in heart failure unless you quickly replace the valves.

So yeah, it's a small risk, but it's a pretty disastrous consequence in case it formulates. The reason we rarely see rheumatic fever in north America is because of how quickly strep throat infections are genuinely addressed-- but again, other nations think that the risk doesn't justify the prescription.

Thanks for the clarity. I was taught in my pre-med degree that strep throat was only cured by antibiotics. That never fully made sense.

When I was a kid we got it a lot and my mother called the doctor and his office called in a prescription, no charge or fee. Things have changed a lot since thwn.

 

[Deleted member 848]

Thanks for the clarity. I was taught in my pre-med degree that strep throat was only cured by antibiotics. That never fully made sense.

When I was a kid we got it a lot and my mother called the doctor and his office called in a prescription, no charge or fee. Things have changed a lot since thwn.

like on paper it makes sense, because Group A Strep is generally susceptible to beta-lactam antibiotics like penicillin, or amoxicillin-- but studies show that taking antibiotics for strep only makes patients return to normal health 24 hours quicker (according to the lectures I got/research I've been exposed to). For this reason, people ask why the extra 24 hours even matters-- the answer is that it wouldn't, if it wasn't for rheumatic fever.

 

[infection]

like on paper it makes sense, because Group A Strep is generally susceptible to beta-lactam antibiotics like penicillin, or amoxicillin-- but studies show that taking antibiotics for strep only makes patients return to normal health 24 hours quicker (according to the lectures I got/research I've been exposed to). For this reason, people ask why the extra 24 hours even matters-- the answer is that it wouldn't, if it wasn't for rheumatic fever.

It has much less to do with rheumatic fever and much more to do with the realities of an interaction with the patient in front of you than the numbers on paper. Antibiotics are still widely prescribed for many clear viral etiologies because it’s a lot easier to make an argument for a possibility of bacterial etiology and acquiesce than it is to have to take 10-15 minutes to educate a patient who 1) feels like crap 2) came in and paid their copay and 3) wants to get better. Add in institutional/systemic bureaucracy and patient satisfaction ratings and it will often push to favor prescribing an antibiotic for a viral respiratory infection. In theory one can be a purest, but where the rubber meets the road you can’t full-court-press on every patient every day because you will crash and burn.

So if someone has strep they feel bad enough to come in, you’re going to throw an incredibly cheap antibiotic at them even if it only shows 24 hour improvement above placebo, because those 24 hours can be valuable not just for symptoms but return to work. In addition, 24 hours is an average, meaning some will have >24 hours and again its compared to placebo, not compared to doing nothing (which is too often what people assume when they think about and discount a placebo effect, which often accounts for real and sizable components of true treatment effects).

 

[Zombie]

Get you someone who will look at you like Jingles looks at Donovan at the end of his ridiculous 3rd quarter

 

[candrew]

Have we ever had to move a game thread to the General Discussion Board?

 

[fishonjazz]

Update: my ear is still draining like crazy (had a nasty greenish yellow looking slug thing exit my ear today) and I’m on the antibiotics which I just learned basically means I’m giving myself cancer.
I can’t hear for ****

 

[fishonjazz]

like on paper it makes sense, because Group A Strep is generally susceptible to beta-lactam antibiotics like penicillin, or amoxicillin-- but studies show that taking antibiotics for strep only makes patients return to normal health 24 hours quicker (according to the lectures I got/research I've been exposed to). For this reason, people ask why the extra 24 hours even matters-- the answer is that it wouldn't, if it wasn't for rheumatic fever.

Hey dala, member when we had that hellacious crazy hike to the hot springs (I’m still proud of my dog Rex btw) and you found my glasses when there was absolutely no hope of finding them but you wouldn’t give up and then you found them by that big rock after the jump over the creek? Good times

 

[Zombie]

View attachment 5653Get you someone who will look at you like Jingles looks at Donovan at the end of his ridiculous 3rd quarter

Derp. I posted this in the wrong game thread.

 

[franklin]

It has much less to do with rheumatic fever and much more to do with the realities of an interaction with the patient in front of you than the numbers on paper. Antibiotics are still widely prescribed for many clear viral etiologies because it’s a lot easier to make an argument for a possibility of bacterial etiology and acquiesce than it is to have to take 10-15 minutes to educate a patient who 1) feels like crap 2) came in and paid their copay and 3) wants to get better. Add in institutional/systemic bureaucracy and patient satisfaction ratings and it will often push to favor prescribing an antibiotic for a viral respiratory infection. In theory one can be a purest, but where the rubber meets the road you can’t full-court-press on every patient every day because you will crash and burn.

So if someone has strep they feel bad enough to come in, you’re going to throw an incredibly cheap antibiotic at them even if it only shows 24 hour improvement above placebo, because those 24 hours can be valuable not just for symptoms but return to work. In addition, 24 hours is an average, meaning some will have >24 hours and again its compared to placebo, not compared to doing nothing (which is too often what people assume when they think about and discount a placebo effect, which often accounts for real and sizable components of true treatment effects).

Holy ****. The amount of insiteful people here blows my my mind. The dude's name is @infection yall].