It’s refreshing to see a major news outlet discussing collateral damage and not just resistance. Over the past decade, 99% of the time antibiotic overuse is covered and warned about it’s always only in regards to resistance.
It’s a good article that also doesn’t spread the common misinformation of “just take some probiotics and fermented foods after antibiotics and you’re good to go”.
Swallowing an antibiotic is like carpet-bombing the trillions of microorganisms that live in the gut, killing not just the bad but the good too, said Dr. Martin Blaser, author of the book “Missing Microbes” and director of the Center for Advanced Biotechnology and Medicine at Rutgers University.
“I think the health profession in general has systematically overestimated the value of antibiotics and underestimated the cost,” Dr. Blaser said.
No shit. And it has spread like a virus to the general populace as well. The majority of people seem mentally addicted to antibiotics and think they’re going to die if they don’t get an antibiotic for every minor issue.
- Find out if you really need an antibiotic.
- Ask for the shortest course.
- Rethink probiotics.
I appreciate the NYT for finally helping spread this.
Just yesterday people on Lemmy were cheering about AI discovering new antibiotics. When I shared info about the concerns of collateral damage, the responses were more unintelligent and close-minded than on reddit. Extremely depressing.
For more info on this subject there’s a wiki and forum at https://humanmicrobiome.info.
tl;dr - Asking your doctor for the shortest reasonable course is a good thing that will both protect you as a patient as well as minimize your risk of antimicrobial resistance. But the key phrase is ask your doctor, do not take it upon yourself to decide when to stop them. Take whatever course you’re prescribed.
Pharmacist and 4th year medical student with a passion for antimicrobial stewardship and infectious disease.
Historical treatment duration for most infections was truly quite arbitrary. Evidence for most infections, when it is actually tested, have pretty consistently demonstrated shorter treatment durations than were classically taught (10-14 days for pneumonia now generally 5-7, 14 days for Gram Negative Bacteremia now 7, etc). There is a subset of infectious disease doctors that are bucking the trend of historical “you have to complete your course advice” for some infections. In general, what I have seen is recommendations to discontinue antibiotics with significant clinical improvement AND a non-life-threatening infection in a non-sterile body cavity. So nobody is shortening course durations for empyemas or endocarditis.
The issue becomes expecting patients to know what constitutes clinically meaningful recovery and whether or not their infection is one of the “safe” ones to stop antibiotics earlier.
At the end of the day, I totally disagree with your premise, as we should always strive for the minimum safe antimicrobial exposure. However I do agree that telling patients “shorter is better” is bad advice because I don’t want laypeople making these decisions when usually no-ID physicians don’t make them.
NYT undoing years of “finish your fucking course”
Yup, it’s hard to have a good discussion about the changing tides in ID without feeling like you’re causing a bunch of backsliding and non-compliance. I think being honest with people that the data is generally poor about how we select durations is the moral thing to do. But I do want you to just take your damn antibiotics as prescribed instead of going rouge because you heard “shorter is better” and your pneumonia recurring.
WITH CITATIONS.
“finish your fucking course” is wrong, and pigheaded people that refuse to review scientific evidence and reshape their opinions accordingly do a lot of harm and make it impossible for the scientific method to work and for the scientific community to update the public when the evidence and consensus changes.
Look man, I gave the link a good and thorough read. Leave the hate at the door. I already said it’s good research, it’s just kind of all over the place.
What that link is saying is already in practice. If it’s a viral infection you won’t get antibiotics, if it’s a clean procedure you probably won’t get antibiotics for more than a day.
That’s already in practice. Because studies show antibiotics are probably not the most important in those select very few cases. Those are good practice methods and are part of IDSA guidelines.
What is not in practice, and what I feel is the main point of confusion here, is that everyone should take shorter courses.
Nope absolutely not. If your doctor says take it for x days then you do it because they already went through the protocol and have deemed X days to be the best course of action. Your doctors will let you know if you are a prime candidate for a shorter duration of therapy, they’ll do all the research for you because they will not risk your death by having your disease state possibly recur and in a more aggressive manner.
Telling everyone that everything should be shorter will only confuse patients. I promise that if you are a prime candidate for a shorter duration, your doctor will know, and will give you the appropriate course of treatment.
Another thing is this quote from the link you provided
“Antifungals also do collateral damage: Disruption of Intestinal Fungi Leads to Increased Severity of Inflammatory Disease https://news.weill.cornell.edu/news/2016/06/disruption-of-intestinal-fungi-leads-to-increased-severity-of-inflammatory-disease. Immunological Consequences of Intestinal Fungal Dysbiosis (2016).
Long-term impact of oral vancomycin, ciprofloxacin and metronidazole on the gut microbiota in healthy humans (Nov 2018)”
It goes on to mention antifungals and then talks about different drugs not related to antifungals but that are instead used as additional therapy for when the exact cause is unknown. I was thinking it would mention AmphotericinB, Voriconazole, Itraconazole, Micafungin etc.
It just seems to be all over the place and is not a great source to base medical decisions off of. I’m sorry.
I’m not as confident as you are in the evidence-based nature/abilities of doctors. See https://forum.humanmicrobiome.info/threads/doctors-are-not-systematically-updated-on-the-latest-literature-what-t.27/
You’re citing forum posts to discussions (with some evidence mentioned within) to support this supposition that doctors are horribly informed and out of date. But I’d like to point out that this is being vastly overblown, and even a 5-10 year out-of-date medical professional has immensely more knowledge and safe ability to recommend therapy than a layperson. I can’t pretend to know the credentials of the individual you’re responding to, but they’re clearly well versed in clinical infectious disease based on their comments, and you’re not supporting your position by citing a forum instead of the actual primary literature that supports your position.
I know from a plethora of experience that this is wrong. It’s also way too broad of a claim. Laypeople knowledge varies a lot. I know first-hand of some laypeople who are actually top experts in scientific/medical fields and I know of people with medical degrees who promote themselves as experts in their field yet they spread harmful misinformation that severely harmed patients and nearly got them killed.
I think this is poorly worded, but I think I still understand what you were trying to say. There is no reason for me to duplicate the forum post here. There are citations there. Copying them here doesn’t make them more legitimate.
Well… here’s my advice. Bring it up to them if you feel they didn’t remember.
I guarantee the pharmacy is also tearing a new one into the doctor for not following guidelines. (If that’s the case) Some pharmacists will outright deny the prescription until either the doctor changes it to what is needed, or another pharmacist is pressured into doing as the doctor says. This has a paper trail. All decisions do.
Medicine is so complicated because there are soooo many things that can be wrong. Usually we get over that by creating specialty care:
Usually, doctors at hospitals are dedicated to a single specific thing. ICU-Trauma, infectious disease, dialysis, diabetes. And they have a team that is also part of that specialty care, pharmacists, nurses, technicians that are all familiar with the specialty.
If an ICU doctor realizes that there is an infection going on, the Infectious Disease team will work on it alongside with the doctor that will treat the trauma as 2+ heads are always better than one.
At the end of the day, your doctor will have to go with what’s better because he has a team dedicated to knowing the exact specifics of all antibiotics and therapies.
As for outpatient treatment, the pharmacy will not fill anything that looks out of the norm before getting some sort of reasoning from the doctor.
Please don’t hesitate to ask any questions when you’re under someone’s care. I’m sure you’ll get an eye roll but shorter durations ARE important, sometimes.
Infectious Disease takes years of mastery, I am nowhere near that, just the basics. The doctors and pharmacists in charge of infectious disease have been buried in literature for years/decades which is why I can only paint a picture and not necessarily describe all the intricacies.
Edit: also brother, sue for malpractice if that was the case for you. It’s not all bad, but you’re right to say that some doctors are meatheaded. That’s why there is a paper trail and guidelines to follow. It’s important that there is trust in our medical pros. I hope that one day you can feel safe again in the hands of doctors.