Wednesday, September 17, 2008

The 'Diff' iculty With Antibiotics

Today's WSJ Health Blog writes about the infection, Clostridium difficile (C. diff), and how it's becoming known as the 'new' MRSA. The blog writes:

The dark irony is that, because C. diff typically kept in check by the healthy bacteria that live in the digestive tract, people often get C. diff infections after treatment with antibiotics (which kill both harmful and healthy bacteria).

It amazes me to this day, how many people come into the office demanding antibiotics for what are mostly viral infections (which of course, antibiotics do not help). I hear the same stories from my colleagues. Usually, once the side effects are rationalized, most people understand the consequences and we decide that antibiotics aren't indicated for this illness. Of course, this approach takes time and unfortunately, it's much easier to write the script for the antibiotic and not have to take more time out of one's busy schedule to explain this.

Just as unfortunate, is that some providers will criticize those non-antibiotic prescribers and scare patients into thinking they had a much more "serious" case of sinusitis than what was originally diagnosed. (I don't know of an ICD 9 code for "serious sinusitis." Is there such one?) Apparently some equate quality care with how many prescriptions are written or keeping everyone happy.

All of these prescriptions and complications from them just add to the wasteful spending in health care today. Don't get me wrong, if a patient needs an antibiotic, they should have the appropriate antibiotic for that current illness. I've also seen many instances where patients are treated with the "latest and greatest" antibiotic for a condition that could've been treated with amoxicillin. Amoxicillin?!?! Yes, amoxicillin. Some hear amoxicillin and think, "oh that won't work for me." "My body is 'immune' to that." We don't get immunity from antibiotics. The onus should be on the provider to explain and educate our patients with facts, not fiction. Shouldn't we already be doing that as providers? With all of the drug ads that we see everywhere on television, print ads, and the like, I guess I can't fully place blame on patients. But alas, this all takes time and time is money and healthcare is ultimately a business. What a vicious cycle.

See another post here on antibiotics that I posted a few months back.


Geoffrey W. Rutledge, MD, PhD said...

I think your blog is terrific, and I would like to feature you on Wellsphere ( Would you drop me an email?
Good health!
Geoffrey W. Rutledge, MD, PhD

Nurse Practitioners Save Lives said...

I did my Master's Thesis on C-difficile. It's one of the main reasons why I try not to prescribe antibiotics on a regular basis. MRSA is coming in the door on a routine basis now too. When will we ever learn?