How Will We Treat Meningitis?
Posted by WhiteCoat on March 10, 2008
Sorry I’m on an anti-antibiotic kick lately, but the news coming out lately is not encouraging. Sometimes it seems like single celled organisms are smarter than we are.
In our town Levaquin is doled out like water to anyone with the sniffles. Guess what? The the resistance rate to Levaquin is 40%. That means that 40% of the infections that used to be cured by Levaquin are now not affected by Levaquin.
Now there is an AM News article out stating that meningococcus has developed a quinolone resistance. Quinolones are the family of drugs that include Levaquin, Cipro, and Avelox. Sure, there are still some medications left - if you’re not allergic to them.
When people demand antibiotics for their colds.
When doctors inappropriately prescribe antibiotics for bronchitis.
When HHS guidelines require physicians to give antibiotics within 4 hours of pneumonia regardless of the cause.
All of these things cause resistance to antibiotics.
When you get meningococcal meningitis and the drugs you receive could make the difference between life and death, now there’s one less drug to help you.
Keep taking antibiotics for colds. In the future when we need antibiotics to treat serious infections, the bugs will have already learned how to beat them and the antibiotics won’t work anymore.
Instead of being able to cure infections, one day the docs will just look at each other, shrug their shoulders, and shake their heads.
My head is already shaking.
March 10, 2008 at 10:19 pm
I thought they were urology antibiotics. Didn’t realize they were used for other things.
I thought my uri was going away and now I am feeling another sore throat all over again.
I have to tell you …I am fantasizing about a nice z-pack right now.
Ahhh…a girl can dream…
BUT because of you and Dr Rob…I know I have to just cool my little antibiotic seeking jets and this too shall pass.
However…if I start opting to drool vs swallow then I’m goin in…cause that only happened with strep.
March 10, 2008 at 10:25 pm
P.S.-I was resistant to many of the antibiotics I got when I had an e-coli infection while stented. And so I had to be admitted prior to the stent removal so I could be put on Rocephin. I think it was Rocephin.
Well whatever it was …it worked and the infection cleared.
Wasn’t there some problem that you wrote about Rocephin a while back?
March 10, 2008 at 10:54 pm
I’m totally in agreement, however…
What about all of the damned livestock that are getting doped up with perfectly good antibiotics? Don’t you think it’s a much bigger problem than what we people are doing?
Just talking in volume alone…those cattle are indiscriminatingly getting fed antibiotics so that we can feed them crap. And there are way more cows eating antibiotics on a regular basis than people.
Good point - one I hadn’t considered.
A quick internet search shows that the antibiotic in cattle feed issue has been around for 10+ years. See also this article.
March 10, 2008 at 11:24 pm
Bacteriophage therapy.
Sure, it’s a bigger hassle for the pharma companies, having a different treatment for every etiological agent, but virii seem to be up to the task.
March 11, 2008 at 12:20 pm
Yeah, phages would kick ass. The bacteria adapts, they adapt faster. The only problem is that it would be very hard to have broad spectrum phages.
March 11, 2008 at 1:30 pm
This is obviously just liberal communist atheist EVIL-lutionist propaganda from a bunch of Darwin worshippers.
//obviously
March 11, 2008 at 7:49 pm
Levaquin has been implicated (or quinolones) in a highly resistance strain of clostridium difficile. This aggressive toxin producing bacteria can wreak havoc on the bowels. Sometimes, in aggressive cases it can result in complete colectomies.
Levaquin is the ER’s drug de jour (at least my ER). It is used for everything from pneumonia, to cellulitis, to abdominal pain.
I have been using less and less of Levaquin due to the massive explosion of c diff colitis I have seen in the last 5 years.
And if you’ve never had it, I can assure you, you don’t want it.
March 11, 2008 at 8:10 pm
Fluoroquinolones have been overmarketed and overhyped, and are now one of the leading causes of Clostridium difficile associated diarrhea. (Amoxicillin still takes #1 because of the sheer number of prescriptions that are written, despite the fact that evidence-base medicine has shown that acute bacterial otitis media rarely ever needs to be treated, and the risk for serious complications is ridiculously low.) And despite these facts, a lot of internists still try to stay away from clindamycin just because that’s what the old-school medical textbooks say.
The beauty of serious bacterial infections (like bacterial meningitis) is that you need IV antibiotics to treat them, and they’re a hell of a lot harder to abuse. You can’t just dole them out like candy the way you can with moxifloxacin or levofloxacin. And while we seem to give everyone who comes to the emergency department or gets admitted to the wards vancomycin these days, we still don’t have an outbreak of vancomycin-resistant Staphylococcus aureus (VRSA), nor do we have rampantly virulent forms of vancomycin-resistant Enterococcus (VRE). (Although maybe it’s just a matter of time.)
On the other hand, there’s another oral antibiotic that gets horribly abused: linezolid, one of the few available treatments for VRE. A lot of people are fooled into thinking that because it’s oral, it must be cheaper. But I’ve actually looked into it, and 14 days of vancomycin IV, including the PICC-line placement and the home care nursing, is still cheaper than 14 days of linezolid by mouth. And linezolid is toxic as hell.
The lesson that needs to be learned is that newer is not necessarily better. The ancient drug penicillin is still the drug of choice for certain diseases (for example, syphilis and actinomycosis.) Imagine, just fifty years ago, we had no treatment for serious bacterial infections. The key is to narrow coverage as soon as you can.There’s no point in using ciprofloxacin when good ol’ amoxicillin or cephalexin will do. Antibiotics are just like any other drug: they need to be targeted against the specific disease, and they can have serious and sometimes deadly side effects.
April 7, 2008 at 9:09 am
I am working on a letter to be submitted to my state board of pharmacy.
The letter suggests: It is time to classify oral antibiotic medications as schedule V controlled substances.
A fruitless (and severely flawed) exercise, I know; but I think the board members would get a kick out of it.
Actually, I think that this is an outstanding idea.
Either schedule antibiotics as a Schedule V or create a separate Schedule VI for them. Those who prescribe antibiotics could be tracked, and, those outliers who overprescribe could be re-educated on when antibiotic prescriptions are appropriate or could even have their privileges revoked if they do not change their habits.