Why We Can’t Have Nice Antibiotics

As someone who has been ranting about the misuse of antibiotics, I can’t believe this still happens, although it does explain the rampant resistance problem in India (the author is an Indian doctor; boldface mine):

A few weeks ago, a viral infection was doing the rounds in my locality, which started off with a sore throat, worsened over the next few days, led to 5-10 days of fever with myalgia and prostration and resolved without any apparent complications with supportive treatment (as is the wont with most viral infections) [Translation: bed rest and reducing the symptoms deals with the infection].

So I had a middle aged male who walked in with a day of symptoms suggestive of this condition and I decided to treat him with Paracetamol [Tylenol]/Ibuprofen, oral fluids and rest. However, he was VERY insistent that he needed an antibiotic to get well, and to placate his fears and establish the absence of any bacterial infection, I sent off a battery of (unnecessary, expensive) investigations. They all came back within normal limits on the 3rd day of his illness. Meanwhile, he was hitting the worst part of his viral infection (note that he was not following any of the medications or rest I had advised for him), and was getting really cranky. When I finally told him that his viral sore throat would not be ameliorated with a dose of antibiotics, he got furious, called me a quack, and left.

A doctor next door obliged him with a script for Cefixime, to be taken for 10 days (it was already his 3rd day of the disease, remember). He got well soon enough, thanked the antibiotic happy doc profusely, swore some more at me, and left.

For those of you keeping score at home, the really scary resistance genes such as KPC or NDM-1, which confer resistance to all penicillin deriviatives (anything that starts with cef- or ceph- or ends with -cillin), also confer resistance to Cefixime, so it’s good we’re using this like Tylenol (I kid. This is a fucking disaster).

And here’s the reason antibiotics are prescribed:

While obviously I am bitter about this issue, the easy way out (and also to gain a paying patient) is to give it to him and be done with it. The other doctor is more experienced than me, and I am sure he too realized that what he was doing with the antibiotic script was basically buying time while the disease ran its course. However, he caved in to the demands of the patient. While I believe I tried my best to counsel the patient and tell him the futility of the antibiotic script, now he believes that those drugs cured him of his miserable illness, so the next time he gets a sore throat he will go more ballistic demanding antibiotics.

Not only are we not preventing the poor, antibiotic demanding behavior of patients, we are also, by default, reinforcing the habit in them…

India right now has a massive antibiotic resistance problem, and the government (or parts of it) seems to be in denial. Irresponsible patients are one major reason why*.

*There seems to be relatively little agricultural use of antibiotics in India.

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3 Responses to Why We Can’t Have Nice Antibiotics

  1. dr2chase says:

    So how come we don’t have a family of placebo “antibiotics” with sexy sounding names to use in these situations? Something like “Progenitorivox“.

    • Min says:

      Second the motion! In the old days doctors sometimes prescribed sugar pills. Why not now?

      Yes, I know the temptation to prescribe them, even when the patient does not demand antibiotics.

  2. Art says:

    This sort of thing, demands for drugs when no drug will really help, are why doctors have been known to prescribe placebos. What you need is a creative selection of a name for a sugar pill that makes the sugar pill sound like it’s an antibiotic. Prescribe a ten day course of the new wonder drug and powerful antibiotic ‘Sucrocillin’. Emphasize that it is new, too new to find in online references, but quite powerful, and let the guy go. When he shows up next time talking about how a Sucrocillin really knocked out that cold, in less than ten days no less, every doctor listening will know what the story is.

    On one hand it is always best to keep a patient well informed and well oriented in fact and reality. On the other, some people don’t do well in a reality centered environment. It is a common mental illness, but one which is beyond the scope of your practice to correct.

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