The Government’s Antibiotic Resistance Plan by Stella Fitzgibbons MD

ab

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.

 

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  2 comments for “The Government’s Antibiotic Resistance Plan by Stella Fitzgibbons MD

  1. DrPhil
    September 27, 2014 at 10:43 pm

    What about the 95-99% of antibiotics (tetracyclines and fluoroquinalones) used in the meat industry. Next time you tuck into some deep fried southern goodness, look on the packet “Hormone free”. Hormone free doesn’t mean low dose antibiotic free. Chickens get to market size 2-3x as quick when fed low dose antibiotics, in squalid crowded conditions. Hmmmmm if I was going to try to generate antibiotic resistance to a gram negative bug, lets see, I’d need fecal matter (fecal oral transmission), cramped hot and crowded conditions, long term use of under-dose antibiotics….. Where could you get such an environment????

  2. Steve_O'_
    September 27, 2014 at 10:03 am

    Our friends and role models the prokaryotes have been about the world for a billion or so years before us, and have laid down a terrific evidence base to show us that you get what you select for.
    Behavior adaptation by regulation pretends to bypass this truth, insisting that one can progress in all directions simultaneously. A thing can only move in one particular direction in one moment in time – that is the characteristic of physical mechanics. We cannot progress in all ways; we are merely likely to progress in the direction which all the forces sum up to.
    In the experienced practice of medicine, one apprehends one clear thing to do next. That thing may well be individual to a particular patient; or it may be a path held in common in the treatment of many patients. By disempowering the physician, one sets the compass in the direction of the fastest rate of increase of healthcare expenses. If there is no best practice for one patient, there is merely a Best Practice for all patients; or merely dozens of conflicting Best Practices, each of which, if violated, can result in punishment for the chooser. To a rat in a cage, it is obvious – do not choose, and merely await the punishment that is inevitable. That is is the compass heading for American medicine – overreaching high costs with even higher costs, and bad outcomes with worse ones. We may assuage ourselves that we have the highest of intentions; nevertheless, we are heading straight for the shoals, no matter how loudly the captain shouts that sinking is unacceptable.

Comments are closed.