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Response to DCBob (Reply #29)

Fri Jun 15, 2012, 10:07 AM

34. it's not a controversial topic at the hospital where I work

C-dificile is known to be caused by overuse of antibiotics. It's kind of a given, but maybe that is just among professionals and not with patients? Problem is that if you have a seriously ill person, they need the antibiotics to stay alive. They are then set up for c-dif. It runs through nursing homes...

Doctors start with the simplest antibiotic(s) that a given microbe is susceptible to and the patient is not allergic to, because they have fewer side effects and are safer as well as cheaper. Unfortunately, past and current overuse -- including and especially on factory farms -- is driving the increase in antibiotic resistance. That forces doctors to up the ante.

And yes, there have been doctors known to over-prescribe (decades ago, before I worked in healthcare) I had a co-worker with the flu demand his doctor prescribe antibiotics. even when I explained to the co-worker the differences between a virus and bacteria, he admitted he knew that. but he still insisted that everything possible be done. The doctor should have thrown him out, but I think back then they just relented because it was easier.

People are stupid, and sometimes doctors give up and give them what they want. No doubt they regret that now....

On the other hand, some doctors aren't too people smart -- or maybe are too constrained for time? We recently had a patient drop off a bloody stool in the lab to be tested for c-dif; she asked us what could cause bloody stool because her son also had diarrhea. On chatting with her, we determined quickly that not only had she been camping recently, but she had been teaching her son "survivalism." I immediately asked if they drank from a stream. Yup. Lab partner and I looked at each other, looked back at her, and answered in unison, "giardia." The doctor was ordering the wrong test; probably didn't have a chance to ask enough questions. Locals also don't realize (or, if tea partiers, don't accept) that climate change has warmed our fresh water to the point that giardia -- which never survived Maine winters in the past -- is now running rampant, along with a host of other microbes that never survived Maine winters before.

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