E-drug: Re: Antibiotic prescribing (2)
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Jay,
You wrote:
My results indicate that patients had an average compliance rate of
less than 60% (range 29 to 91%) but we observed a 100% cure rate.
My concern is that Physicians are over-prescribing given these
results.
How did you diagnose infection and cure?
We have gone away from specific diagnosis and treatment in favour of
the (WHO?) syndromic approach. Eg. a protocol for genital ulcers
covering both Syphilis and Trach.
I am wondering whether erythromycin is a "very forgiving" drug when
is comes to maintaining therapeutic blood levels vs the timing of
the dose taken, or whether my assumption of adequate serum levels of
6 hours per dose is incorrect.
I like to give erythromycin 8 hourly in an acute Asthma attack [moderator:
antibiotics in acute asthma attack? We would only use it for exacerbations
of chronic obstructive lung disease. And not erythromycin] but
give it 6 hourly in STD because that is what the STD protocol requires
(in pregnant and lactating women, else doxycycline) for ten days.
1. Where does the standard 10 day course of therapy come from (What
is it based on)?
I'd like to know too.
3. Are we prescribing too much?
"Much helps Much." :-)-O [moderator:? strange statement, not sure I
understand it. If you mean prescribing more is better, I totally disagree]
Most Antibiotics have a very wide therapeutic range and toxicity is
almost a non-issue.
[Note from moderator:
For antibiotics I think the issue is not as simple as using serum
levels alone.
That is a very important statement.
Further, some will recommend giving iv antibiotics by continuous
infusion, others by bolus.
This is quite true. In the Aminoglycosides it is in fact better to
give the whole daily dose in one shot rather than 8 hourly. Less renal
problems and at least not more ear problems. Much more convenient as well.
[moderator: same effect not documented for all infections]
Also, the penetration to the focus of the infection is important,
and lastly the sensitivity towards the microbe in question.
I totally disagree with the order here. Culture and Sensitivity must
come first, not last :-)-O[moderator: I did not intend to make an order, I
fully agree culture is no. 1!]
Very often we are prescribing too much, cf. historical development
in treatment of UVI. Here in Norway we even recommend 14 days for C
trachomatis, I have no idea where it comes from. Kirsten Myhr]
That may be too long, but not necessarily too much :-)-O
el
--
Dr. Eberhard W. Lisse\ / Swakopmund State Hospital
<el@lisse.NA> * | Resident Medical Officer
Private Bag 5004 \ / +264 81 1246733 (c) 64 461005(h) 461004(f)
Swakopmund, Namibia ;____/ Domain Coordinator for NA-DOM (el108)
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