Respect the potential wrath of a drug

I should be hard at work right now seeing patients in the office, and I would be if it weren’t for one little pill.

Have you ever been frustrated by a physician refusing to give you an antibiotic?  That very scenario occurs daily in primary care.

“It is only a virus.”

The arguments against taking an antibiotic (cost, side effects, allergic reaction) can seem less than convincing when you are feeling sick. Also, one little prescription is unlikely to have global impact on the antibiotic resistance of bacteria.  Watchful waiting is never what you go to the doctor seeking.

Recently, I was reminded why I must respect the potential wrath of a drug.

This morning I took my first dose of an antibiotic for a persistent sinus infection after weeks of watchful waiting.  I won’t name the drug, but it had never caused a problem for me before–no antibiotic had.  I did not think twice before taking it.

About an hour later, while trying to help a woman with a painful toe, I noticed that my upper teeth felt funny, almost numb.  By the next appointment I was itching all over and my face was so red that one could tell from across the room that something was amiss.  The development of hives confirmed my suspicion of an allergic reaction.

Fortunately, the reaction did not progress so fas as to require emergency treatment, but attending to my afternoon appointments was out of the question.  This experience has definitely been an inconvenience for me, as well as the ten people expecting to see me today.

It is not always crystal clear who should get an antibiotic, and who should not.  Physicians try to apply their experience and clinical judgement to decide whether the potential benefits outweigh the risks.

Believe me, there are indeed risks–I now have personal experience with one.

Stephen Meyers is a family physician who blogs at The Med Savings Blog.

 

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  • http://natickpediatrics.net Rob Lindeman

    Dr. Meyers,

    As you are already judicious about your use of antibiotics, I suspect in the future you will avoid even more strenuously the temptation to prescribe antibiotics for acute sinusitis? As you know, the evidence does not support antibiosis for this entity.

    • http://www.medsavingsblog.wordpress.com Stephen Meyers

      You raise an excellent point. There is always the question of when the line has been crossed. For my situation, both my treating physician and I had agreed that symptoms lasting six weeks no longer could be classified as “acute.”

      Since you brought it up, what have you found is the most effective way to handle an individual who is determined to take an antibiotic for acute sinusitis?

      • http://natickpediatrics.net Rob Lindeman

        Great question, Dr. Meyers. The short answer is that there IS NO effective way to handle such an individual. Let me tell you what I try, though:

        I explain that everything we do in medicine is a balance between benefits and harms. When something I do is more likely to help than to harm, I’m inclined to do it (with the patient’s consent). When the balance tips to parity or harms outweigh benefits, I don’t treat. Some’s get it, some’s don’t.

  • http://theYogadr.com Kathleen Summers

    I’m curious if you tried any natural therapy before resorting to antibiotics. I’ve found teaching neti, the saline flush, to my patients helps many of them. They’re happy to be healed without pills – and there’s some pretty good science behind it.

  • gzuckier

    If placebos were ethically acceptable, medicine would take a giant stride forward.