Overprescribing antiobiotics

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Funke

Funke

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Is this a big problem in family medicine? What is taught about antibiotics in residency? I'm curious because I'm in microbiology and we're talking about bacterial resistance. For example, I went to the doctor today for what I thought might be strep. She spent less than a minute with me, then gave me a shot of 1g Ceftriaxone and 1 mL betamethasone before the tests were back. I tested negative for streptococcus and for mono. Then I got a Z-Pak prescription and a methylprednisolone prescription. She hardly spoke a word the entire minute she spent with me, only to tell me the tests were negative. Didn't even tell me what else it might be.

Isn't the prescription of strong antibiotics a leading cause of bacterial resistance? I've also been shadowing physicians including infectious disease specialists, so I see the reality of resistance on very frightening levels.
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It's a problem, but not one limited to family medicine. I see more unnecessary antibiotics prescribed in the urgent care and ER settings than I do in FM. At least in FM, we're usually more willing and able to spend a little extra time explaining to people why they don't need an antibiotic. Your case is obviously an exception. I'd look for another doctor.
 
That's interesting about EM overprescribing. I didn't think about that. It actually was an urgent care I went to, so I might have brought that one on myself. But it says urgent care/family medicine, so I figured it would be kind of family medicine oriented, but it was more a shoot first, don't ask questions, send them out the door type place. I'm strongly considering family medicine, so I was kind of surprised that prescribing strong antibiotics for a probable virus infection is so blatant. But again, that might have been due to the urgent care part. They seem to have doctors in and out of that place a lot.
I really want a family doc that is going to spend time with me and tell me what's going on, discuss treatments, even for small things like viral pharyngitis. And that's the kind of doctor I want to be, too.
 
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I don't think you can really lay it on family medicine compared with specialty medicine. As a Hospitalist I see just about every specialty covering their bases with primary care more likely to back off then most of the other specialties. The fact that X-rays are notoriously non-definitive often times with different reads by different radiolgists and then again by pulmonologist together with castostrophic cases with infective vs pneumonitis and ARDs being fairly common in the hospital setting together with the fact that antibiotics are utilized for COPD exacerbations with a large amount of patients having at least a touch of COPD that aren't a whole lot of docs who are wiling to gamble. In fact I've seen where infectious disease docs commonly and inexplicably use the big gun expensive antibiotics despite sensitivity reports indicating little or no resistance. Hopefully the rotation of available antibiotics will allow one step ahead.
 
Shot of Ceftriaxone? Why? lol.

I would think even if it was Strep throat, a Zpack would probably be as far as one would go. I've seen FM docs even give Amox with great results. But cef? common now.
 
septoplasty said:
Shot of Ceftriaxone? Why? lol.

I would think even if it was Strep throat, a Zpack would probably be as far as one would go. I've seen FM docs even give Amox with great results. But cef? common now.
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Depends on what he/she was thinking about. Pencillin VK would be first line for strep except for kids which would be amoxicillin. Drawback for Pencillin VK is 4 times a day unless its the one time shot. Draw back with shot is can't take it back and rapidly available is an allergy. Rapid strep tests are wrong 10%? of time? (if i remember correctly) and are supposed to be backed up with confirmatory test. As everyone knows strep is easy to kill. Rocephin and azithromycin together are one of the first line community acquired pneumonia treatments. Zpack might be good for a suspected bacterial sinusitis. It's hard to talk smack about somebody when you weren't there, have no allergy history, didn't examine the patient and are relying on a history that was given anonymously on the internet. Explaining exactly in detail what the thought process is to the patient would be ideal in a perfect world but not always possible depending on whether the patient is prone to argue, overdiscuss, or tangential. You are always walking in the danger zone whenever you start to feel smug about the treatment of patients. Humility and striving to get it right are what delivers the best care. Just my 2 cents
 
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MedicineDoc said:
Depends on what he/she was thinking about. Pencillin VK would be first line for strep except for kids which would be amoxicillin. Drawback for Pencillin VK is 4 times a day unless its the one time shot. Draw back with shot is can't take it back and rapidly available is an allergy. Rapid strep tests are wrong 10%? of time? (if i remember correctly) and are supposed to be backed up with confirmatory test. As everyone knows strep is easy to kill. Rocephin and azithromycin together are one of the first line community acquired pneumonia treatments. Zpack might be good for a suspected bacterial sinusitis. It's hard to talk smack about somebody when you weren't there, have no allergy history, didn't examine the patient and are relying on a history that was given anonymously on the internet. Explaining exactly in detail what the thought process is to the patient would be ideal in a perfect world but not always possible depending on whether the patient is prone to argue, overdiscuss, or tangential. You are always walking in the danger zone whenever you start to feel smug about the treatment of patients. Humility and striving to get it right are what delivers the best care. Just my 2 cents
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Amen to that one --- just tonight when doing an admit, caught myself sliding into accepting what the ED doc worked up as the DX....and had to mentally adjust to "I'm hearing this for the first time and need to keep the differential broad".....I usually find that when I'm rushed or just plain tired is when I'm most susceptible...
 
Yeah I'm probably being too hard on the doctor. From my little knowledge of micro it did seem like a strange choice, especially the way they went about the whole process. Anyhow, I'm going to find an established, well-recommended family doctor in the area instead of going to the urgent care from now on.
Related to this, and to the possible overuse by hospitalists and ID docs, I was reading earlier about vancomycin resistant enterococci. It sounded like it could be a potentially large threat for the near future. But I certainly don't want to say these doctors are using vancomycin when they shouldn't, because honestly I'm going to want whatever will kill my infection most thoroughly even if it has a potential of growing VRE. But my micro books seem to be calling for hospitals to tone down the use of vancomycin so that Staph aureus doesn't become resistant.
Anyway, I find this stuff pretty interesting. But I should probably be a little less quick to think a doctor made a wrong choice. That one might have some karma for me in a few years :)
 
MedicineDoc said:
Depends on what he/she was thinking about. Pencillin VK would be first line for strep except for kids which would be amoxicillin. Drawback for Pencillin VK is 4 times a day unless its the one time shot. Draw back with shot is can't take it back and rapidly available is an allergy. Rapid strep tests are wrong 10%? of time? (if i remember correctly) and are supposed to be backed up with confirmatory test. As everyone knows strep is easy to kill. Rocephin and azithromycin together are one of the first line community acquired pneumonia treatments. Zpack might be good for a suspected bacterial sinusitis. It's hard to talk smack about somebody when you weren't there, have no allergy history, didn't examine the patient and are relying on a history that was given anonymously on the internet. Explaining exactly in detail what the thought process is to the patient would be ideal in a perfect world but not always possible depending on whether the patient is prone to argue, overdiscuss, or tangential. You are always walking in the danger zone whenever you start to feel smug about the treatment of patients. Humility and striving to get it right are what delivers the best care. Just my 2 cents
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Thank you for this response. Difficult to give PCN when 1) it's not even carried in your office and 2) 80% of the patient's who come through the door state a PCN allergy. Rocephin is my injection of choice because it's my ONLY choice in my clinic way on on an island in the middle of nowhere. I'm in a closed community where the illness just gets passed on to everyone and then when the original sick group has finally recovered, they start getting sick again and the cycle continues. Many of my patients I see have already been sick for many many days and come in looking like death warmed over, high fever, severe cough, and NO MONEY for OTC medication or prescriptions. Many times what I can give them in the clinic is the ONLY treatment they will receive because they make the choice between buying food and buying medicine. I use Z-Pak all the time too, but there in no guarantee that the patient will pick it up and my goal is to keep them out of the ER since I cover that too.
 
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