abx for dog bite question for you clinical folks

[prevacid]

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i had a patient come in with a ER script for augmentin 875, he had a dog bite in his right hand which was cleaned in the ER....the guy has no insurance and is paying cash....even thou augmentin is generic, it still costs like 70 bucks, which was too much for him...i asked him if taking 2 pills was ok with him and he said yes

so i call the doc, and he says switch it to clindamycin + bactrim, however, same problem, clindamycin is 60 some bucks...I suggested doxy and flagyl, i figured flagyl covers B. frag, and the doxy gets the other gram +, etc....the doc was totally against that option and told me to stick with wat he said (despite me telling him the pt barely had 20 bucks on him)....so i told the patient and he just left without getting anything

considering the circumstances, what would your recommendation have been?

 

[WVUPharm2007]

Doxy would work....old skool.../\.

 

[MRSA Sucks]

I'm not a MD but shouldn't he get a rabies shot?

 

[WVUPharm2007]

I'm not a MD but shouldn't he get a rabies shot?

tetanus, too...but they prolly took care of that at the ED.

 

[Fuzzychickens]

i had a patient come in with a ER script for augmentin 875, he had a dog bite in his right hand which was cleaned in the ER....the guy has no insurance and is paying cash....even thou augmentin is generic, it still costs like 70 bucks, which was too much for him...i asked him if taking 2 pills was ok with him and he said yes

so i call the doc, and he says switch it to clindamycin + bactrim, however, same problem, clindamycin is 60 some bucks...I suggested doxy and flagyl, i figured flagyl covers B. frag, and the doxy gets the other gram +, etc....the doc was totally against that option and told me to stick with wat he said (despite me telling him the pt barely had 20 bucks on him)....so i told the patient and he just left without getting anything

considering the circumstances, what would your recommendation have been?

So...did the doctor not understand that the patient had 20 bucks and the other option was for the patient to get nothing?

I think the doc was pissed off that you would suggest anything - you know because a pharmacist has no clue about drugs.

Or it could be the liability fear kicking in. If he sticks to his guns and the patient doesn't buy the medication the blame is out of his hands even if the pat gets worse. On the other hand if he takes your suggestion on a treatment plan that he may not be familiar or comfortable with and the patient gets worse, a million desperate-for-work lawyers will be crawling all over that guy to sue the pants off the doc.

How much of daily decisions do doctors weigh against the probability of getting sued?

 

[MountainPharmD]

Why is clindamycin 60 bucks? For that matter why was the Augmentin 70 bucks? Prophylactic antibiotics are usually prescribed for only three to seven days. Even Augmentin, for that short of time, should have been inexpensive.

You must work at CVS or Walgreens who have the most expensive cash price of any chain pharmacy. I would have sent him to Walmart.

 

[Aznfarmerboi]

i had a patient come in with a ER script for augmentin 875, he had a dog bite in his right hand which was cleaned in the ER....the guy has no insurance and is paying cash....even thou augmentin is generic, it still costs like 70 bucks, which was too much for him...i asked him if taking 2 pills was ok with him and he said yes

so i call the doc, and he says switch it to clindamycin + bactrim, however, same problem, clindamycin is 60 some bucks...I suggested doxy and flagyl, i figured flagyl covers B. frag, and the doxy gets the other gram +, etc....the doc was totally against that option and told me to stick with wat he said (despite me telling him the pt barely had 20 bucks on him)....so i told the patient and he just left without getting anything

considering the circumstances, what would your recommendation have been?

Tell him to go home and get more money...

 

[ttopping]

ERs charge way too much when it comes to meds...

 

[prevacid]

Why is clindamycin 60 bucks? For that matter why was the Augmentin 70 bucks? Prophylactic antibiotics are usually prescribed for only three to seven days. Even Augmentin, for that short of time, should have been inexpensive.

You must work at CVS or Walgreens who have the most expensive cash price of any chain pharmacy. I would have sent him to Walmart.

yes ive already stated b4 here i work for wags in PA and OH
the last time i told some1 to go to walmart, the tech told the DM and the DM went crazy (in email exchanges, not in person), as Im already looking to leave the company, i dont want any more trouble b4 i put my 2 weeks in

it was written for augmentin * 10 days, i think he was going of the sanford guide, not sure

 

[prevacid]

tetanus, too...but they prolly took care of that at the ED.

yea tat was taken care in the ER

 

[prevacid]

last evening, his fam doc called me, told me tat ER doc was a fill in and a punk, said the wound wasnt bad looking at all, and called in doxy for him which the guy picked it up later last night