from the what-doesn’t-kill-you-makes-you-stronger dept.
An estimated 70% of primary care physicians reported in a survey that they would still prescribe antibiotics to treat asymptomatic infections based solely on a positive urine specimen. This is despite long-held medical guidelines recommending against this practice, according to a new study published today in JAMA Network Open, which was led by University of Maryland School of Medicine (UMSOM) researchers.
Since 2005, medical organizations have been advocating against the routine use of antibiotics to treat patients who have bacteria detected in a urine culture but no symptoms of a urinary tract infection (UTI) like burning or frequent urination. Overwhelming evidence indicates that the medications are not helpful for asymptomatic patients and could lead to adverse health effects like diarrhea, vomiting, rashes, and yeast infections. [...]
Family medicine physicians were more likely to prescribe antibiotics unnecessarily compared to other specialties. Physicians who were in residency training or who resided in the Pacific Northwest were less likely to prescribe antibiotics.
"We found other factors also played a role in prescribing like whether a physician had a stronger preference in favor of over-treating a condition and fear of missing a diagnosis; that person was more likely to favor prescribing antibiotics compared to a physician who felt more comfortable with uncertainty in practicing medicine," said study leader Daniel Morgan, MD, MS, Professor of Epidemiology & Public Health at UMSOM.
Journal Reference:
Jonathan Baghdadi et al, Exploration of Primary Care Clinician Attitudes and Cognitive Characteristics Associated With Prescribing Antibiotics for Asymptomatic Bacteriuria, JAMA Network Open (2022). DOI: 10.1001/jamanetworkopen.2022.14268
(Score: 5, Informative) by mhajicek on Monday May 30 2022, @04:49AM (13 children)
Antibiotics can mess up your digestive system for a long time.
The spacelike surfaces of time foliations can have a cusp at the surface of discontinuity. - P. Hajicek
(Score: 0) by Anonymous Coward on Monday May 30 2022, @05:13AM (1 child)
Not to mention the microchips.
(Score: 1, Funny) by Anonymous Coward on Monday May 30 2022, @12:03PM
Tell me about it, they keep shrinking those Pringles cans.
(Score: 1, Interesting) by Anonymous Coward on Monday May 30 2022, @06:52AM (3 children)
Nah, just make your own yogurt, plenty of places on the internet to buy live cultures.
Have it for two days in a row once you finish the antibiotics course and you may be better than before.
(Score: 0) by Anonymous Coward on Monday May 30 2022, @01:29PM (2 children)
What's the difference between homemade and store bought yogurt? I'm not sure you can find yogurt in the store that doesn't' have live cultures.
(Score: 0) by Anonymous Coward on Tuesday May 31 2022, @03:29AM (1 child)
Lots of sugars, artificial flavoring and preservatives?
Sure you can buy organic premium ones or with nothing added but they aren't cheap, at least in my neck of the woods - making your own is.
(Score: 0) by Anonymous Coward on Tuesday May 31 2022, @04:00PM
I wholeheartedly agree about making your own being cheap and easy. I have a sous vide stick and it is perfect for making yogurt because I don't have any other device that will hold the temp around 110F. (There's the "stick it in the oven with only the lightbulb on" way, but my oven lightbulb doesn't work and I already had the sous vide heater).
I was just curious if you were saying that homemade was healthier from an active culture perspective.
(Score: 3, Interesting) by pTamok on Monday May 30 2022, @09:12AM (5 children)
There's a case to be made for fæcal sampling before a course of antibiotics and an autologous fæcal transplant afterwards. The research that is going into how we are affected by our gut flora is showing just how fundamentally our general health is connected to our gut flora. There's even good evidence that the particular individual's biome of gut flora affects susceptibility to obesity.
To use a little hyperbole: it is possible that the (over)use of antibiotics could, in future, be compared to the over-use of pre-frontal lobotomy: although thankfully, (*)the damage to your gut-flora's biome can be remediated by a non-autologous fæcal transplant of a biome from a healthy individual. (Note: Do NOT try this at home. Medical fæcal transplants are screened for pathogenic bacteria and fungi).
To be fair, asymptomatic infections sometimes should be treated. The untreated side-effects of infection can be serious, depending on the infection - such as heart-valve damage, liver damage, amongst other things. Doctors should be able to tell the difference between 'benign' infections and non-benign: that is what they are paid for. There is also the problem of being sued by patients accusing them of medical malpractice. From the doctor's point of view, prescribing antibiotics could well be a cheap and easy way of avoiding a malpractice suit.
(Score: 2) by krishnoid on Monday May 30 2022, @09:46PM (1 child)
I've wondered if/why doctors don't recommend taking probiotics (if those are a real thing) on an empty stomach right after a course of antibiotics, to try to repopulate the gut. An autologous fæcal transplant would be a gold standard, but seems like it would be a lot more involved.
(Score: 0) by Anonymous Coward on Saturday June 11 2022, @08:46AM
They do actually assign probiotics with/after the course of antibiotics, 3 days or 1/2 the length of the antibiotic course.
(Score: 3, Interesting) by requerdanos on Monday May 30 2022, @11:24PM (2 children)
If you accept this view (and I do--an untreated UTI can lead to kidney infection, which can progress to kidney failure and death, both undesired outcomes), then you have to reject the view stated in TFA/TFS that:
[*] But here, unspecified.
I would think that avoiding kidney problems by treating a diagnosed bacterial infection with appropriate medication would be a pretty sound thing to do. I would prefer my own UTI or that of a family member be treated vs. left alone. But I am not a doctor.
The key here, for which I give the would-be prescribing doctors credit over the 'prevailing wisdom,' is that in these cases disease-causing organisms are not simply suspected, but actually confirmed.
As I understand antibiotic misuse, it's irresponsible to throw antibiotics at symptoms where there is only a vague suspicion of an underlying treatable infectious agent (or none at all in the case of viral infections). This doesn't seem to fall into that pattern, and would seem to hardly support the view that "Most Doctors Still Believe In Prescribing Unnecessary Antibiotics" in general. Can anyone in the know share what's so overwhelmingly bad about this practice?
(Score: 2, Interesting) by Anonymous Coward on Tuesday May 31 2022, @04:40AM (1 child)
It is more complex than untreated bacteria in urine equaling possible progression to pyelonephritis. It turns out the real situation is more complicated than that. You have to consider how many species are in the urine, what kind of species are there, the relative amounts, patient history, contamination sources, what other findings exist, the probability of conditions, and more. You then have to balance that against whether they will benefit from treatment and the adverse events and side effects. There are plenty of reasons that bacteria could be in the urine and not all of them lead to kidney or other problems if untreated. Many people live decades with asymptomatic bacteriuria and never get a UTI or asymptomatic cystitis and not all UTIs require treatment to resolve.
(Score: 2, Interesting) by pTamok on Tuesday May 31 2022, @06:42AM
Absolutely. A stick-test (dipping a stick in urine) [patient.info] is usually pretty non-specific. Most usually it will indicate if you have an infection, but not which organism is causing the infection. See Home Urinalysis Test Strip Color Chart and Explanations [disabled-world.com]
The easy approach if the stick-test indicates an infection is to prescribe some broad-spectrum antibiotics. It's cheap, quick, and gets the patient out of the door. A 'gold standard' would be to identify the infecting organism, and decide then whether treatment is necessary, or prescribe a more specific antibiotic. Unfortunately, this is expensive, as it requires more testing, and possibly growing cultures, which takes time, and the end result is either 'do nothing', 'wait and see' (i.e. retest later), or treat, which you would have done anyway without extra tests and extra appointments. And, if you don't treat, you can be sued for medical malpractice - "The test showed I had an infection and it wasn't treated!!!". It is no surprise that there is overuse of antibiotics.
The dirty secret that doctors don't tell you is that most things get better 'by themselves', so prescribing sugar pills (aka homoeopathy) will appear to work. Occasionally things do need treatment, but it is not easy to distinguish between patients that actually need treatment and those that don't, which is why protocols are developed from the experience of many thousands of patients. In this case, for most patients, NOT prescribing antibiotics is fine: but for a small number, it isn't.
Stick tests are great, and we need more of them that allow the quick determination of the infecting organism - just like SARS-CoV-2 tests (which is why Theranos [wikipedia.org] was a big deal - medical testing is a huge industry). Some doctors use a drop of blood (finger-stick/finger-prick) test to determine infection status and help decide if antibiotics are needed, but it is still not the 'gold standard' of taking a blood sample of venous blood and sending it of to a lab for time-consuming (and expensive) testing. Doctors are 'simply' playing the odds, and using their experience to treat patients most effectively.
(Score: 2) by JoeMerchant on Monday May 30 2022, @08:03PM
Kirk : [to McCoy] Whass happening to my mouth?
Leonard 'Bones' McCoy : You got numb-tongue?
Kirk : NUM-TUNG?
Leonard 'Bones' McCoy : I can fix that!
[hurries off to find another hypospray]
Contemporary doctors are just the same.
Україна досі не є частиною Росії Слава Україні🌻 https://news.stanford.edu/2023/02/17/will-russia-ukraine-war-end
(Score: -1, Troll) by Anonymous Coward on Monday May 30 2022, @04:51AM (1 child)
Doctors are NOT scientists. They are more like auto mechanics, like the ones that keep insisting you to change oil every 3k miles.
(Score: 1, Funny) by Anonymous Coward on Monday May 30 2022, @07:16AM
Good God, I can't imagine myself traveling 3k miles without taking a leak.
(Score: 4, Insightful) by looorg on Monday May 30 2022, @11:16AM
... or is it the patients that "demand" it and the doctors can't really be arsed to tell them to just stay at home for a few days and suck it up and rest and things till pass?
If the patient doesn't get it from Doctor A they just go to Doctor B etc until they get what they want.
Or are they so afraid of getting sued that they find it better to do something they can't be faulted for instead of doing "nothing". If something happened etc ...
(Score: 4, Interesting) by mcgrew on Monday May 30 2022, @02:31PM (5 children)
I didn't know this until I started reading Saving Capitalism, the drug companies legally bribe doctors to prescribe their poisons. I say "poisons" because that's how so many Americans got addicted to opiates; the Sacklers and others bribed doctors. It also explains why my own doctor prescribed $40 worth of pills for a single high blood pressure reading. I bought an automatic tester, the drug was completely unnecessary and my forty bucks was wasted.
Carbon, The only element in the known universe to ever gain sentience
(Score: 4, Informative) by JoeMerchant on Monday May 30 2022, @08:11PM (4 children)
We needed a pharmacological intervention.
Our MD learned of a good one from a rep on their weekly free lunch for his office staff. The "new" drug, which is really good to damp down impulsive behavior, is a combination of two well known drugs: quinidine and dextromethorphan. The rep gave him free samples which we tried right away: great stuff. Only $10 per pill, two pills daily.
Luckily, our MD also understands that $7k+ per year is unreasonably steep for us, even if the rep does throw over 50 free lunches for his staff (costing a couple hundred dollars each) per year, so he wrote us a script for a lower quinidine compound that works just as well and has a lower risk of cardiac arrhythmia side effects. Cost for the custom compounded pills? $0.50 each.
Україна досі не є частиною Росії Слава Україні🌻 https://news.stanford.edu/2023/02/17/will-russia-ukraine-war-end
(Score: 0) by Anonymous Coward on Tuesday May 31 2022, @12:16AM (3 children)
Does your MD still get to bang the drug rep?
(Score: 2) by JoeMerchant on Tuesday May 31 2022, @02:25AM (2 children)
If he wanted to, probably, as long as he's writing enough scripts that get filled.
Україна досі не є частиною Росії Слава Україні🌻 https://news.stanford.edu/2023/02/17/will-russia-ukraine-war-end
(Score: 0) by Anonymous Coward on Tuesday May 31 2022, @02:44AM (1 child)
Makes you feel warm inside, don't it? :)
Sheeeit.
(Score: 2) by FatPhil on Wednesday June 01 2022, @09:14AM
Every time I pay $5 for an ambulance ride, consultation, and chest x-ray, I curse our bloody communism, or whatever it is you keep accusing us of having.
Great minds discuss ideas; average minds discuss events; small minds discuss people; the smallest discuss themselves
(Score: 0, Troll) by VLM on Monday May 30 2022, @06:35PM
Good thing they would never prescribe unnecessary vaccinations.
(Score: 0) by Anonymous Coward on Monday May 30 2022, @06:53PM (3 children)
Around 25 years ago, I had my appendix removed. When I talked to the doctor after the operation, I asked, don't I get a prescription for prophylactic antibiotics? He assured me that the operation was done so precisely that there was no need for antibiotics. Well, a few days later, I had a fever and chills and was shaking. I drove myself to an urgent care clinic and the doc there said yep, you have sepsis, and put me on an IV drip. I felt better within hours. All this because the doctor refused to give me a prescription for "unnecessary" antibiotics.
(Score: 3, Informative) by pTamok on Tuesday May 31 2022, @07:08AM (2 children)
I guess you survived, didn't you?
The trouble with prophylactic use is that it increases the risk of antibiotic resistance developing in bacteria, and for most patients, it is unnecessary. The next problem is, you can't predict with any degree of certainty who is likely to need the antibiotics beforehand. So you do a patient evaluation: the young and fit don't get prophylactic antibiotics, but do get told what the signs of infection are, and not to ignore them. People who are older, less fit, and who have underlying health conditions that mean infections are more serious for them will get the prophylaxis. At the time you asked about prophylactic antibiotics, the doctor did not know whether you would need them or not; and there is a risk evaluation involved in deciding whether you get them. Of course, doctors won't normally tell patients that.
Antibiotics are also not a riskless proposition. Some people are allergic to particular antibiotics; and some cause kidney damage Antibiotics induced acute kidney injury: incidence, risk factors, onset time and outcome [nih.gov]to a greater or lesser extent.
(Score: 1) by shrewdsheep on Tuesday May 31 2022, @07:29AM (1 child)
It's a matter of weighing benefit and risk. Both common sense and clinical studies indicate that prophylactic antibiotics should be given following appendicitis, the case reported by GP therefore clearly being a case of malpractice.
(Score: 2, Informative) by pTamok on Tuesday May 31 2022, @09:23AM
I would not say it is clear malpractice. (Note, in reading the articles, SSIs means Surgical Site Infections)
I could cherry pick and point to this study: Should prophylactic antibiotics be given perioperatively in acute appendicitis without perforation? [nih.gov]
or this study: Role of antibiotic prophylaxis in surgery for nonperforated appendicitis [nih.gov]
or this study: Post-operative antibiotic use in nonperforated appendicitis [nih.gov]
or this study: https://pubmed.ncbi.nlm.nih.gov/21958510/ [soylentnews.org]
or this study: Postoperative antibiotic therapy after appendectomy in patients with non-perforated appendicitis [nih.gov]
There's more. Basically postoperative antibiotics in addition to preoperative prophylactic use do not improve outcomes. The OP describes talking to the doctor after the operation.
As for general prophylactic use, there is a Cochrane review
Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. [nih.gov]
The OP describes being diagnosed with sepsis, which is an uncommon sequela following appendectomy:
Incidence and risk of sepsis following appendectomy: a nationwide population-based cohort study [nih.gov]
So, overall, it can be argued (via the Cochrane review) that it is reasonable to consider prophylactic antimicrobials, but it is not unreasonable to decide against it. Even if a single dose is given prophylactically, a post-operative course does not improve outcomes. Note that that review was published after the OP had an appendectomy.
Yes, prophylactic antibiotics are now routine for abdominal surgery - see below
Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines [nih.gov]
Acute appendicitis–advances and controversies [nih.gov]
There's a recurring thread in the papers pointing out that good surgical conditions that reduce the risk of wound infection is at least as important as use of antimicrobials. I've seen absolutely lousy infection control in what are supposed to be flagship hospitals, which seems to be a staff engagement issue more than anything else, and is a chronic problem in most healthcare systems. Putting bored people through training courses won't change their subsequent behaviour, and practices within the operating theatre and subsequent wound management really need to be sharpened up.
(Score: 2) by krishnoid on Monday May 30 2022, @09:26PM (2 children)
So maybe this is different in other countries or areas of the US, for better or worse?
(Score: 0) by Anonymous Coward on Tuesday May 31 2022, @02:13AM (1 child)
I know in Panama there's at least one antibiotic you can get over the counter.
(Score: 2, Interesting) by pTamok on Tuesday May 31 2022, @06:57AM
You can get OTC antibiotics in many countries. Sigh.
Or, just be a farmer and buy in bulk to use them as growth enhancers for cattle and chickens. It works, which is a problem. Antibiotics of 'last resort' are used by farmers in China: Scientific American: Superbug Resistant to Last-Resort Antibiotic Arises in China [scientificamerican.com]; Review of antibiotic resistance in China and its environment [sciencedirect.com]