MRSA too expensive to treat

[PharmDstudent]

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Someone has MRSA. They've had multiple relapses, because they can't get rid of it. The main problem is that they can't afford the treatment options: medications, emergency room visits, etc. This situation is very disheartening.

I'm also concerned about the MRSA spreading to other people. I cleaned the relevant surfaces with alcohol after this person left, but was that enough? What should I do if I encounter this person again in the future?

 

[elwademd]

wash your hands.
tell said person to wash his/her hands. and stop sratching his/her nose/ass crack/groin and then touching his/her other parts.

 

[dgroulx]

Bactrim is cheap, works on MRSA, and is taken orally. No need for hospitalization.

 

[PharmDstudent]

Bactrim is cheap, works on MRSA, and is taken orally. No need for hospitalization.

Thanks! I'll keep that in mind.
It just seems like their health care professional kept pushing vancomycin or Targocid. The complaints were: hundreds of dollars to treat the infection, which was too expensive and resulted in relapse.
They've had this infection surface 25 times and it usually turns into a big lump.

 

[Epic]

2 types of mrsa, communuty acquired and nosocomial.
And many different tx options. Some cheap some not. Will elaborate later when I have a full keyboard.

 

[Aznfarmerboi]

For community acquired pharmacy, most mrsa are suspectible to bactrim. Other cheap options include tetracycline and clindamycin. In terms of prevention, the cdc found out that a lot of time, washing hands alone can prevent mrsa.

However, i saw that u mention vancomycin and targocid which suspect me to believe you are talking about hospital acquired mrsa. Since mrsa is highly purlent, drainag is something you cannot avoid. Suspectibility tests are almost necessary if the infection is coming back again and again. This no matter what means $$$. The best thing to do is to find a good hospital.

 

[WVUPharm2007]

I saw a patient a few weeks ago whose bug was resistant to linezolid. You just kinda sit and think for a second....just a few more mutations and we're screwed..

 

[PharmDstudent]

Thanks for the replies, everyone.
I just felt so helpless when I was initially confronted with this case of MRSA. The person was in tears, and my boss didn't even know what the acronym stood for.
I had to explicate the type of infection, handle the person's OTC products, and take some course of action to decontaminate the environment.
I washed my hands and sprayed them with alcohol afterwards, along with spraying the hard surfaces.

My greatest fear is that this person will spread it to others, including myself or my co-workers if they return. I don't like fretting about the worst case scenario, but this infection seems bad.

 

[Requiem]

My greatest fear is that this person will spread it to others, including myself or my co-workers if they return. I don't like fretting about the worst case scenario, but this infection seems bad.

Do you understand it's pathogenicity? I did a hospital rotation this summer, tons of MRSA. I'm fairly confident if you cultured my lab coat / clothes / hands you'd probably get MRSA daily. If you're healthy, you're not going to develop some horrendous systemic MRSA infection - you probably won't even get sick. A healthy immune system can handle itself, just keep clean and don't touch your face. It's not like it's the plague or anything.

 

[njac]

It's not like it's the plague or anything.

and even if it were, it only takes a little doxy to clear up some y.pestis. 👍


oh how I love the desert.

 

[Requiem]

and even if it were, it only takes a little doxy to clear up some y.pestis. 👍


oh how I love the desert.

Have you read Dooms Day Book by Connie Willis? Excellent book, written about time travel back to the 14th century [1350 or so] and witnessing the black plague.

 

[Epic]

Community acquired MRSA is resistant to beta lactams but susceptible many different abx such as Doxy, Bactrim, Clinda, and sometimes quinolones. It's become fairly prevalent among HS athletes in showing up with cellulitis.Nosocomial MRSA is slightly different. C/S may show MRSA to be susceptible to Doxy, Bactrim, and Clinda...in vitro. But in vivo, trying to treat nosocomial MRSA with those drugs may be challenging.

Vancomycin is still the drug of choice but we have witnessed a steady rise in MIC. Therefore now we're shooting for levels between 15 to 40ug/ml. However, we are seeing more and more treatment failures with Vanco. It's disappointing since Vanco is still somewhat cost effective in a hospital setting.

We do have other treatment options suce as Zyvox, Tygacil, Synercid...which are very expensive. Ceftobiprole, the 5th generation cephalosporing with MRSA coverage will be launched by Ortho McNeil soon...but will be very costly.Vanco is bactericidal but does not penetrate tissues very well. Tygacil and Zyvox are bacteriostatic.

The new beta lactam of course will be bactericidal.Zyvox does provide an oral option for outpatient treatment of nosocomial MRSA...but at $120 per day cost and probably $150 per day to the patient, it's an expensive treatment option.

 

[njac]

Have you read Dooms Day Book by Connie Willis? Excellent book, written about time travel back to the 14th century [1350 or so] and witnessing the black plague.

no, but I should. I love that stuff.

but y.pestis is still here in New Mexico. When I worked at the vet diagnostic lab we got dozens of positives in cats and dogs every summer. A couple weeks ago a toddler was misdiagnosed and died of it.

I'm just sayin' the plague isn't any big deal anymore as long as it gets caught in time.

 

[trx]

Community acquired MRSA is resistant to beta lactams but susceptible many different abx such as Doxy, Bactrim, Clinda, and sometimes quinolones. It's become fairly prevalent among HS athletes in showing up with cellulitis.Nosocomial MRSA is slightly different. C/S may show MRSA to be susceptible to Doxy, Bactrim, and Clinda...in vitro. But in vivo, trying to treat nosocomial MRSA with those drugs may be challenging.

Vancomycin is still the drug of choice but we have witnessed a steady rise in MIC. Therefore now we're shooting for levels between 15 to 40ug/ml. However, we are seeing more and more treatment failures with Vanco. It's disappointing since Vanco is still somewhat cost effective in a hospital setting.

We do have other treatment options suce as Zyvox, Tygacil, Synercid...which are very expensive. Ceftobiprole, the 5th generation cephalosporing with MRSA coverage will be launched by Ortho McNeil soon...but will be very costly.Vanco is bactericidal but does not penetrate tissues very well. Tygacil and Zyvox are bacteriostatic.

The new beta lactam of course will be bactericidal.Zyvox does provide an oral option for outpatient treatment of nosocomial MRSA...but at $120 per day cost and probably $150 per day to the patient, it's an expensive treatment option.

My class is studying antibiotics in therapeutics right now.. our second test is Monday. I am not near where you are in terms of processing info. Is this info second-nature to you? How would you (or anyone with experience) suggest that I learn my abx? Does anyone know of a good website/book that I can use for therapeutics class? Thanks!

 

[WVUPharm2007]

Really, as with most therapeutics related issues, you just have to break down and memorize the stuff. Which, yes, is incredibly boring. But oddly, once you memorize it the stuff seems to stick pretty well. It comes in handy during rotations when they ask you what to give for what bug/infection.....which does come up frequently....even though 80% of the time you can get away with just saying "Uhhh...Augmentin!!"

I always liked to come up with a bunch of cartoons or bizarre analogies that helped me understand actual concepts.

Like making an analogy in my brain that giving clavulanic acid is like giving the bacteria AIDS....

....Or like Fort E coli:

 

[PharmDstudent]

You should have added a super hero or two for extra drama , as if a battering ram wasn't enough.

 

[Epic]

My class is studying antibiotics in therapeutics right now.. our second test is Monday. I am not near where you are in terms of processing info. Is this info second-nature to you? How would you (or anyone with experience) suggest that I learn my abx? Does anyone know of a good website/book that I can use for therapeutics class? Thanks!

Yes, it's second nature to me....it's what I do for living..and ID is one of the top priorities in what I do. Both clinical and financial.

A couple of weeks ago, I posted how to study ID....check my previous posts..

 

[WVUPharm2007]

Yes, it's second nature to me....it's what I do for living..and ID is one of the top priorities in what I do. Both clinical and financial.

A couple of weeks ago, I posted how to study ID....check my previous posts..

After doing inpatient rounds for a few weeks, I could see how one who does it professionally would become very comfortable with ID in a short amount of time due to forced exposure. It's like cellulitis grows on trees....

 

[Epic]

After doing inpatient rounds for a few weeks, I could see how one who does it professionally would become very comfortable with ID in a short amount of time due to forced exposure. It's like cellulitis grows on trees....

You have to like antimicrobials.... If you're good at it...you'll be valuable.