Antibiotics: Dosage

[Enmos]

Split from thread: "Broke foot and heart problem all at once "

why do you think its bad that nurses (and doctors but its mainly nurses who give out medications in hospital) act to ensure the right drugs are going to the right person?

I have herd innumerable stories of the wrong drugs being given to people or by the wrong route (sub cut dosages being given IV for instance), nurses therefore use what may seem to be an overly formal system to ensure that this doesnt happen

The 5 rights plus 1

Right Medication (including expiry date)
Right Person (which is why you must say your full name and date of birth)
Right Dose
Right Time
Right Route

and Write it down

I think it's bad that they give the lowest possible dosage of antibiotics (and multiple times, because a low dosage might not do it).
Imo, it would be much more efficient if they do not give out the lowest possible dosage, but a higher dose. That way you have to worry less about resistance and more people will be cured in one go without the need for repeat treatment and eventually perhaps the need to operate in order to cut away the infected parts by hand.

 

[Twelve]

I think it's bad that they give the lowest possible dosage of antibiotics (and multiple times, because a low dosage might not do it).
Imo, it would be much more efficient if they do not give out the lowest possible dosage, but a higher dose. That way you have to worry less about resistance and more people will be cured in one go without the need for repeat treatment and eventually perhaps the need to operate in order to cut away the infected parts by hand.

What's more, very often doctors don't prescribe the right antibiotic in common diseases like tonsillitis, ear infections, ... As a result of it, when you finish the treatment, you get sick again. I wonder why they don't order the best antibiotic for you.

 

[Asguard]

I think it's bad that they give the lowest possible dosage of antibiotics (and multiple times, because a low dosage might not do it).
Imo, it would be much more efficient if they do not give out the lowest possible dosage, but a higher dose. That way you have to worry less about resistance and more people will be cured in one go without the need for repeat treatment and eventually perhaps the need to operate in order to cut away the infected parts by hand.

you may want to look at some recent research into the problems CAUSED by the over use of non targeted antibiotics. Firstly everyone is afraid to use the strongest antibiotics in any but the most life threatening cases in case things like MRSA and TB become resistant to them too. They also have inherent side effects in there own right which are very nasty and lastly there is the new research coming out. I found this article which ironically comes from the OTHER abc from the one I first herd it on.

Overuse of Antibiotics May Cause Long-Term Harm

By MIKAELA CONLEY (@mikaelaconley)
abc (the US one)
Aug. 25, 2011

While antibiotics have certainly benefited many in myriad ways, an overuse of antibiotics may be changing our entire bacterial makeup, says Dr. Martin Blaser, chairman of the department of medicine at New York University Langone Medical Center.

In his opinion piece published in the journal Nature, Blaser implores doctors to be more prudent in prescribing antibiotics because of these potential changes, and because overprescribing can cause antibiotic resistance, which has received much attention in recent years.

"Antibiotics are miraculous," Blaser told ABC News. "They've changed health and medicine over the last 70 years. But when doctors prescribe antibiotics, it is based on the belief that there are no long-term effects. We've seen evidence that suggests antibiotics may permanently change the beneficial bacteria that we're carrying."

In the editorial, Blaser hypothesized that the overuse of antibiotics may even be fueling the "dramatic increase" in many illnesses, including type 1 diabetes, allergies and inflammatory bowel disease by destroying the body's friendly flora, or protective bacteria.

"We need to cut down on excess use," said Blaser. "Over time, the scientific community has to create a more narrow spectrum of antibiotics to kill specific organisms and not all bacteria, but we don't have those yet."
Dr. Cesar Arias, assistant professor of infectious disease at University of Texas Medical School, wholeheartedly agreed with the editorial.

"We use these without much care and without really thinking," said Arias. "People go to the doctor for a sore throat, which is usually viral, and they're get antibiotics."

"These drugs affect what we're colonized with, particularly the digestive tract," said Arias. "If you alter your flora, you can promote certain superbugs to colonize in your gut and get into the bloodstream."

The average American child will receive 10 to 20 courses of antibiotics by the time he is 18 years old, and one-third to one-half of pregnant women will receive them during pregnancy, according to Blaser's report.

But it is not always easy for doctors to cut back on prescribing antibiotics if a patient wants it.

Overuse of Antibiotics May Cause Long-Term Harm

"Physicians are often placed in unpleasant situations when patients demand antibiotics for themselves or their children, even when it is not in their best interests," said Dr. Philip Cunningham, associate professor of biological sciences at Wayne State University in Detroit. "Patients must understand the reasons when antibiotics are not prescribed."

Whether or not people can overcome resistance and change is not widely known yet.

Prevention is the key," said Dr. Richard Colgan, associate professor of family and community medicine at the University of Maryland School of Medicine. "The best way to avoid antimicrobial resistance is to be judicious in using antibiotics. That is not to mean that if your doctor recommends [antibiotics] you should discard this advice."

While part of the answer is to reduce antibiotic intake when possible, Blaser said he speculates and fears that humans have already lost some "ancestral organisms" that help protect us.

"I think we'll soon be inoculating babies with these lost bacteria," said Blaser. "Antibacterials are everywhere. We might be harming ourselves out of a lot of benefit."

Viewed 19/01/12 at 11:01

There is also good evidence that the over use of antibacterials is causing increases in severity of infections, the increase of autoimmune diseases, allergies, asthma etc. The body needs to fight and we keep taking the fight away but back to your comments, rather than stronger and more broad spectrum drugs, we need to be cutting back to only using them when its life threatening and getting medications which are as targeted as possible. Just imagine if we got to the stage where bacterial meningitis and meningococca were producing drug resistant strains

 

[Enmos]

you may want to look at some recent research into the problems CAUSED by the over use of non targeted antibiotics.

Exactly. Overuse.
Overuse being when an antibiotic is applied too often.
It's better to apply a higher dosage (note: I do not mean highest dosage) once and then operate (or go for 'exotic' antibiotics) if it doesn't work, instead of applying a low dosage multiple times before operating or using other antibiotics.

Firstly everyone is afraid to use the strongest antibiotics in any but the most life threatening cases in case things like MRSA and TB become resistant to them too. They also have inherent side effects in there own right which are very nasty and lastly there is the new research coming out.

I wasn't talking about these 'strongest antibiotics'.
I was arguing for administering a higher dosage of a particular antibiotic rather than administering multiple low doses of the same antibiotic.
This reduces the number of times an antibiotics is applied within the population and it gives better and clearer results.

I am also of the opinion that doctors and the like should be very clear to the patient that they will administer the antibiotic just once and then pursue more conventional methods (if possible) if it doesn't take.
What they do now, or at least this is my experience, is just prescribing an antibiotic without informing the patient what the strategy is should it not take. If they have a strategy, that is. It doesn't look like it..
In my case, my dentist prescribed me the same low dosage antibiotic 5 times over a span of 6 years for a recurring root-canal infection. He denied my request for a stronger dosage the first and second time.
End result: After six years of suffering I was finally sent to see a surgeon in order to have the infection chiseled out of my jawbone. Which hurt like hell, by the way.

The dentist should have prescribed a stronger dosage the first time, increasing the chance of success.
Then, if it didn't work the first time, he should have sent me to the surgeon.
It's also more cost-effective this way.

There is also good evidence that the over use of antibacterials is causing increases in severity of infections, the increase of autoimmune diseases, allergies, asthma etc. The body needs to fight and we keep taking the fight away but back to your comments, rather than stronger and more broad spectrum drugs, we need to be cutting back to only using them when its life threatening and getting medications which are as targeted as possible. Just imagine if we got to the stage where bacterial meningitis and meningococca were producing drug resistant strains

I don't know what it's like in your country, but here they only use antibiotics when it's clear that the body isn't coping with it itself.
But they should pursue other methods sooner when antibiotics fail to do the job. (Edit: Or pursue other methods straightway if possible. But I guess that's a cost-issue..)

There.. I have spoken!

 

[Asguard]

Enmos you are american are you not? That article i linked to was a US abc article about the over use of antibiotics IN THE US. Ie you present at a GP (family doctor i think you call them) with what 90% of the time is a vial infection but you expect pills so the doctor prescribes antibiotics which will do NOTHING because its a virus. what they SHOULD be giving is Ibuprofen, codeine, antihistamine and pseudoephedrine because they will help the symptoms while the body fights off the infection. However this isn't what's happening, maybe this isn't your experience but it IS what's happening generally. There was a big push back about this a while ago here too.

Oh as for doses, they shouldn't be being set by the doctor at all with exceptions like antidepressants and insulin, morphine and other medications like that which DO need to be modified for individual patients. This isn't what doctors are trained to do (or dentists), this is why the FDA, TGA and other organisations like it exist. The doctor should be following the guidelines set down for the individual medication, not making it up as they go and the guidelines should be set by the best science available as to the effective dose of that particular drug

 

[Enmos]

Enmos you are american are you not?

Nope. I'm Dutch.
They, the dentist, my doctor, and the surgeon, all agreed that it was a bacterial infection.

Oh as for doses, they shouldn't be being set by the doctor at all with exceptions like antidepressants and insulin, morphine and other medications like that which DO need to be modified for individual patients. This isn't what doctors are trained to do (or dentists), this is why the FDA, TGA and other organisations like it exist. The doctor should be following the guidelines set down for the individual medication, not making it up as they go and the guidelines should be set by the best science available as to the effective dose of that particular drug

That could be the reason they denied me a higher dosage, I doubt it however.
The dentist filled out a form (that I needed in order to get the antibiotics) that had four different dosages on it (of the same antibiotic) with check boxes. He always checked the lowest dosage.
By the third time he prescribed it to me i knew it wasn't going to work (as in that it was going to come back after some time). But what could I do? At that point, you just want the swelling to go away ASAP.