I see that the federal government is unveiling a plan to prevent and counter antibiotic resistance. Pardon me while I look at the factors that brought it about.
In the hospital we are under constant pressure to shorten patient stays. Giving an antibiotic that only covers 95% of the pathogens likely to cause our new admission’s infection–horrors, we might have to change it after the cultures come back. And we do that even if the patient is clinically better, forgetting that most of our dehydrated elderly with UTIs would get better with IV fluids alone and that many of those respiratory cultures represent colonization rather than disease. A much more expedient choice is to give Gorillacillin or Megaquin right there in the ER, since it covers a whopping three percent more of the possible bugs even if it does cost ten times as much.
Hospitals all over have countered by sending out e-mails, restricting use of Gorillacillin and stressing isolation procedures. But at the same time they use their beloved electronic records to see which doctors get those UTIs discharged fastest. And if your patient satisfaction rating dropped because Grandma was still confused on Day Two, you get a black mark for that too.
We can’t open a medical journal without hearing what a big advance these medications are.. Less nephrotoxicity! Once daily dosage! Ingenious cartoons to help us remember the name! (Remember that picture of a tiger?)
Meanwhile we are seeing more and more resistant bugs, more C. difficile raging through ICUs and GI tracts…and complaints from financial officers about the price of these wonderful new concoctions.
I thought that evidence-based medicine was supposed to be the gold standard for treatment. Too bad nobody’s looking at all the pressure to ignore it.