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Author Topic: Are antibiotics over prescribed?  (Read 2235 times)

Offline cheryl j

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Are antibiotics over prescribed?
« on: 25/03/2015 04:54:40 »
In response to a  facebook post from Natural Newa about "super bugs" several people commented on the unnecessary use and over use of antibiotics. If you google the topic, you will see other main stream media articles besides the (in my opinion) discreditable Natural News source, claiming much the same thing.

But I'm still skeptical. I have a hard time imagining a doctor or nurse practitioner prescribing
antibiotics with no culture results or no symptoms indicative of a bacterial infection, based on their clinical experience. I can easily imagine a doctor prescribing broad spectrum antibiotics to a very sick person when they aren't immediately sure what's wrong, or prophylactically for some types of surgery. I don't see that kind of risk management as wrong, since you can't always "wait and see how it turns out." But it's been my experience working in a clinic, that for mild respiratory illnesses, doctors usually go with "it's probably viral" unless they have a good reason to believe otherwise. I doubt, too, that doctors are bullied into writing antibiotic scripts by aggressive patients, or for placebo effect.

In the discussion mentioned above, I argued that resistance in bacteria  is a consequence of natural selection and likely to result even if antibiotics are used appropriately. If I'm wrong, who are all these mystery doctors  supposedly overprescribing antibiotics and why do they do it?



 

Offline evan_au

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Re: Are antibiotics over prescribed?
« Reply #1 on: 25/03/2015 10:35:13 »
Quote
who are all these mystery doctors  supposedly overprescribing antibiotics and why do they do it?

I think the patient expectations come into it - they expect the doctor to give them a pill that will make everything better.
I have heard of doctors rationalising it as something like "You have a virus, but maybe there is a secondary infection?".

With antibiotic resistance on the increase, there is certainly more awareness now of the need to use antibiotics more wisely.
  • Killing all your gut bacteria is now seen to be a bad idea.
  • But antibiotics are still used widely in healthy animals. 

Quote
resistance in bacteria  is a consequence of natural selection
Viruses, bacteria and fungi have been at war with each other forever.
So it's not surprising that a mould which grew on an orange would produce something (penicillin) that killed bacteria.

And it's not surprising that if you look in soil samples, you will find some bacteria that are immune to penicillin. So it doesn't have to wait for evolution in a bacterium that infects humans - the genes already exist in the wild. What it takes is horizontal gene transfer from an immune bacterium to one which infects humans.

The more antibiotics are used, the more that immune species will thrive, and increases the chance of transfer into human pathogens.

I heard of a recent study, where they succeeded in growing bacteria which live in the soil, but don't grow on laboratory culture dishes. From soil samples from the garden of one researcher (and grown in-situ in that garden), they managed to grow colonies of many new bacterial strains, and identified a number of chemicals with interesting antibiotic properties.

This route may give us some new antibiotics, but it will take the usual 10 years and 10 billion dollars to get each one approved for widespread use in humans and animals. Once approved, the challenge will be to ensure that they aren't going to be used widely in humans and animals! So who is going foot the bill?
« Last Edit: 25/03/2015 10:38:34 by evan_au »
 

Offline alancalverd

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Re: Are antibiotics over prescribed?
« Reply #2 on: 25/03/2015 20:29:01 »
The answer to the question is "no" and "inevitably".

It's sensible to prescribe antibiotics wherever there is a risk or existing infection. So it's a good idea to treat infectious disease with antibiotics, and to prevent postsurgical infection with a prophylactic dose. You migt even say that, if it is justifiable to rear farm animals, it is ethical to minimise the risk of infection and crossinfection which cause suffering or loss of profit. 

The problem is God, who, in his infinite wisdom, created bugs with labile DNA such that a few may survive, and in the absence of competition, thrive, thus producing antibiotic-resistant bacteria.

So to some extent, every prescription of antibiotics benefits the patient but puts the rest of society at future risk. Thus the definition of "overprescription" depends on whether you are interested in the present or the future. 
 

Offline cheryl j

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Re: Are antibiotics over prescribed?
« Reply #3 on: 26/03/2015 01:44:52 »
Once approved, the challenge will be to ensure that they aren't going to be used widely in humans and animals! So who is going foot the bill?

I don't know how it works in other countries, but in Canada, I believe doctors have to have authorization to prescribe a new class of antibiotic. They must have lab results that show the bacteria is resistant to everything else, or some other reason, like an allergy.
 

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Re: Are antibiotics over prescribed?
« Reply #3 on: 26/03/2015 01:44:52 »

 

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