I highly doubt that. We're dealing with a young and otherwise healthy female. The vast majority of sinus infections will resolve on their own. Also, decongestants may just be as effective as antibiotics in minor sinusitis. Why not try a decongestant/saline therapy and see how the patient responds first?
If she's such a healthy female, why does she have sinusitis? What would've happened if she tried on decongestant? You think she would have been cured? So, decongestant..fail....go back to doc, amox..fail..go back to doc, augmentin, fail..go back to doc Avelox..fail... is that what you want?
Isn't standard of care for acute sinusitis is to start with amoxicillin first and see where it goes? Step therapy, start with amoxicillin, if it fails you go with Augmentin. Insurance would pay for Augmentin because your using appropriate step therapy. Its not up to me to decide whether or not a patient should be treated with abx, thats up to the MD. However, if they are going to treat the patient, they should use appropriate treatment methods. Just because amoxicillin is not the most effective drug antibiotic available doesn't mean we have to bust out the biggest guns in our arsenal to treat a common ailment. Its comparable to us dropping a nuke on a small town just because we think that infantry may not be enough to get the job done. It just doesn't make sense.
What is the typical sensitivity of Amox against strep pneumo? What is the success rate? You've said it yourself above that if MDs are going to treat..they should treat appropriately. Then with the rate of resistance against amox by strep pnumo, does Amox make it appropriate? I'll answer it now. NO.
You really think Avelox is the biggest gun????? Does it cover h-MRSA? Effective against serious Pseudomonas? C-Difficile? VRE?, LRVRE?, Acinetobacters? ESBL producing enterobacter species? Carbapenemase producing gram negatives?
Please...if don't go around saying Avelox is a last resort..it can't even treat simple h-MRSA infection.
You think Avelox is a nuke? Get real. It's damn quinolone not much better than Levaquin except for slight anaerobe coverate? Avelox can't even treat bulk of UTI. I hope you know why. Is Avelox better than Cipro for hospital acquired Pneumonia? Enlighten us.
Also, antibiotic resistance, hear of it? Your advocating using top shelf antibiotics just because their free? So we should stop using zpaks and amoxicillin and start wasting our best antibiotics for common ailments? Is this not what got us into this mess in the first place?
See my comment about Avelox above. Reform your opinion on why Avelox is not the "best" antibiotic.
Ok Einstein. Strep Pneumo...one of the main bugs for sinusitis. What's the typical resistance rate of Strep Pneumo against Avelox and Levaquin?
Culturing I agree is not particularly possible in this situation.
So, now you changed your mind that C/S isn't so feasible after you said if a physician is going to prescribe Abx, they should C/S?
If were going to waste abx on a more than likely viral infection, I'd like us to not waste our best abx available to treat it.
You think Avelox is the best in treating Sinusitis?
Moxi should only be limited to adults with a proven and serious/life threatening infection.
why? I'm talking about serious and life threatening.
It only approved by the FDA for acute bacterial sinusitis with restricted use,
Tell us about the restriction.
as well as pneumonia. It is more appropriate to use it for multiple drug resistance CAP
Why is it more appropriate for MDR CAP?? Why can't it be used for non MDR CAP? And what MDR bacteria are you talking about?
and intraabdominal infections.
Is that right? what are the common bugs for intraab infections? And you're going to use Avelox as the last resort abx for Intraab?
It should also only be used when other treatment options have failed.
Tell us about the other treatment options you just mentioned. What regimen for what infections?
That sounds like more of a last line drug to me,
So you're going to use Avelox as the last line when patient with psedomonal UTI with MRSA penumonia with MIC of 2 and Intraab infection with ESBL enterobacter species..right?
And do I have to answer about quinolones side effect profile? Tendon rupture, prolonged QTc leading to TDP, etc.
You said Avelox has larger side effective profile compared to other quinolones. Are you telling me above side effects aren't associated with quinolones or Avelox has more of it than the other quinolones? Get real.
Amoxicillin failure leads to Augmentin being covered because of step therapy. Every insurance reject I've seen for Augmentin was based off this reasoning.
Big deal...in this instance, she would have gone from Amox to Augmentin to Avelox anyways... so she would have been exposed to 2 other antibiotics on top of Avelox...and you're telling me I'm promoting resistance??
At least she still has her money right?
I wouldn't take Avelox if my doc gave it to me, even if it was free. Tendon rupture is rare but guess what? Its a helluva nasty side effect.
And how often does this happen and it doesn't occur with other quinlones?
Every ID pharmacist I've learned from has told me one thing: Quinolones suck.
But wait, you said Avelox and the best abx should be reserved and last resort... the last line. So does it suck or is it so good we have to reserve it? Make up your mind.
I think I have. As a synopsis, multiple drug resistant bacteria emerged because because of your thought process.
Where did I say Avelox was the first line? I haven't said anything what should have been the first therapy. You jumped to that conclusion. I"m picking your brain because you're throwing out substantial claims.."last line therapy" "save the best abx" "larger side effects profile"... so I'm just trying to get you to back up your claims.
You welcome.
She was thanking me too. After her Avelox failed to make her feel better, I used pharmacist OTC counseling, told her to buy some pseudoephedrine and drink plenty of fluids. Wouldn't you know it? The Sudafed worked! Love that drug 🙂
How do you know it was the sudafed or if the infection cleared? btw...
