Antibiotic questions, post your opinion please! Health professionals, Pharmacists wanted too!?

Question

If you are a health professional, pharmacist, or just know alot about antibiotics, I have a few questions I'd loved if you answered!

1. Why is it important to finish all prescriptions?

2. Prevalence of antibiotics (for doctors, pharmacists): How often do you prescribe antibiotics?

Answer 1

While our Canadian friend posted an excellent summary, allow me to interject on a few points.

It is important to finish the full prescription of an antibiotic to prevent resistance. Remember that saying "Whatever doesn't kill you makes you stronger"? Holds true for bacteria as well (to a certain extent). And please bear with me for this over simplification:

As was alluded to in the previous post, there are a few different concentrations that we worry about. These refer to the level of drug in the body that is considered toxic to the bacteria. Below this level, you kill some of the bacteria, but just tick off the other ones...that is the one's that have an innate resistance to the drug. By not getting the drug levels to the needed concentrations for the prescribed time you have selected out the strongest bacteria.

Now for most people their immune system will finish the job (antibiotics just ease the burgen a little). But what if you pass the bacteria along to someone else? Say, someone who's immune system has been weakened by a drug (e.g. immunosuppressant), or another disease (e.g. HIV), or they have a defective immune system (Di Georges syndrome). Now the drug you were prescribed, will be less effective for someone who really needs it.

Antibiotics are ubiquitous for some physicians (internists, pediatricians, emergency medicine, surgeons, infectious disease specialists). Others almost never prescribe them (pathologists, radiologists).

My only comment about the immune system becoming "lazy" is a quote from a microbiology professor "Despite all our antibiotics, it is the body that must destroy the last bacteria".

Answer 2

OK. Big questions. But I will give it a try for you. I am a Medic with the Canadian Military, so I do actually know what I am talking about here, so I will throw my two cents in:

1) It is important to take all of the antibiotics because the infection in the body will adapt to certain levels of the antibiotics in the blood. You will feel great once the initial effect of the antibiotic kicks in, but the infection is persistant. Taking all of the antibiotics ensures that the levels of medication are too high for the infection to survive. More medication than infection equals a healthier you.

2) We try to limit the amount of antibiotics we prescribe. The simple reason is that some people think that they are the magic bullet that kills everything, and the people become dependant on the meds. Then their own immune system just becomes lazy, and won't fight off any infections on its own. Also some of the nastier bugs out there have adapted to the antibiotics. Penicillin is being used less and less for this very reason, too many bugs out there are becoming penicillin resisant.

We do try to limit the amount we prescribe, but we will prescribe antibiotics if they are called for. We usually limit the course of dosing to the shortest effective time, plus a few days to ensure that the infection has been resolved. This limits the dependancy, and doesn't allow the bug to adapt and become medication resistant.

I hope this helps.

Answer 3

1. It is important to make sure the bacteria is completely gone. The ones which are more resistant will stay around longer, and will need more treatment. Not finishing an entire course of antibiotics will cause great harm to you and others. The over prescribing of antibiotics and people not finishing them are major causes of antibiotic resistance. Antibiotics should only be given when there is a confirmed bacterial infection. In the past several years, I only know of 3 new antibiotics, and of the 3, two have already reported resistance. The 3rd one can only be given in a hospital.

2. Antibiotics are very commonly given. They are prescribed too often. Too many times, doctors do not test before prescribing. We are seeing a great increase in the number of antibiotic resistant bacteria. We do not want to go back to the pre-antibiotic era, and so, caution must be observed.

Answer 4

It's estimated that about half of all antibiotics prescribed are prescribed inappropriately, so there's a degree of invalidity in the question, but here goes:
You may be aware that in order for a drug to be sold/prescribed it has to be tested and studied, and in the US those studies are reviewed by the FDA. Some of those studies are "dose-ranging" studies (there are also dose-ranging studies done later, after they hit the market, that are published in medical journals). These will show that, for example, a three-day course of sulfamethoxasole-trimethoprim effects a cure for cystitis in 94% of the treated test subjects, compared to only 90% of those treated with a single larger dose. That is to say, what you're prescribed is what's known to work. Many people make the mistake of thinking that feeling better means that the infection's gone, but that is a dangerous assumption and often untrue. And if you partially treat an infection, the remaining germs are there for Darwinian reasons, so the return of the illness will be harder to treat and may be resistant to the original antibiotic.
As to your secondary question, I prescribe antibiotics pretty well every day, but I'm known to be conservative in my prescribing habits, and I p*** off somebody at least once a week for refusing to prescribe antibiotics for a viral illness.

Answer 5

i can answer question #1, you finish what is prescribed in order to maintain a constant blood level of the antibiotic so it will be more effective at destroying the antigen