Comments on: And You Thought Those Free Pens Are Useless

By: Laurie

Laurie — Sat, 18 Aug 2007 03:55:22 +0000

Nathan., there are indications for the use of some of these “super antibiotics”, I would never deny that. What concerns me as a medical professional is the misuse of the “new” drugs for infections that don’t require it. I have had a family member who was given Tygacil for an ecoli infecion and he was absolutely deathly ill from it. It was very scary to see how bad the nausea and vomiting was. We switched to another drug which worked well. That is my gripe….why go to Tygacil or Vanco when an organism has been isolated and there are other options with a better side effect profile?
OK, I’ll get off my soapbox!
Yes, Jason…we are on the same page on this one. See, I’m not a radical activist!! LOL!

By: Nathan

Nathan — Sat, 18 Aug 2007 03:21:07 +0000

This is Nathan from DrugRepToys. To quell the evident fears of those readers here, I’ll say in clarifying my post that the infection we were considering was by no means a simple UTI. This was a very sick ICU patient, which was the reason the hospital pharmacist was rounding with us. And that, though I’ll freely grant that pens contribute to name brand awareness, I’m not basing my prescribing decisions upon them. I’ve actually seen a case of Tygacil-induced pancreatitis, so though I value the drug for situations where it is appropriate, I have a healthy consideration of its side effects too.

Thanks to Phamalot for the link.

By: jason

jason — Sat, 18 Aug 2007 01:33:28 +0000

Thanks Laurie, glad others are on board - even those that rarely agree with me. My wife will tell you I am hard to agree with most of the time, and she is right!

I do agree that newer is not always better, and there are some reformulated pharma gimics out there. But there are also vital advances that we are reluctant to credit pharma for as well. If you have looked at the new cardiac guidelines, Beta blockers are no longer first line therapy for uncomplicated htn. I have heard that B-blockers were the best choice for the last 15+ years, since med school and likely in place even longer than that.

MRSA doesn’t scare me. Now the increase in VRSA and VRE due to increased vanco use - now that scares me. Thank goodness we do have some newer antibiotic (linezolid, etc) for vanco failures. Thank goodness in my area we also have good ID docs that keep the use of these vital antibiotics down and prevents the potential emergence of resistance.

Again, I think the problem is that there are some many areas that need improvement. Lisa VS will tell you that we need focus on pediatric antidepressants, I will tell you infectious disease is the key. GP’s will tell you about pts that are non-compliant are making practicing medicine tough. Others will tell you there is mismanagement in cardiac cases. The real problem is that we do need more specialists. The old phrase “jack of all trades, master of none” is true in medicine as well. I hate to say that because I am a FP - but luckily for my patients I know my limits and love to get consults when needed. Just know when you get treated, if it is serious, you do want the opinion of at least 1 specialist.

Have a great weekend everyone!

By: Laurie

Laurie — Fri, 17 Aug 2007 20:36:56 +0000

Jason, I totally agree!!! It is ALL about education of docs. The antibiotic overuse and misuse is rampant. We are starting to see hospitals/pharmacists step in on some of the problem prescribers, which is a good thing.
And it’s not just Tygacil….we are seeing Vancomycin used as a first in drug for the elderly patient who hasn’t taken an antibiotic in years, who has an uncomplicated UTI.
Physicians have to start to realize that “newer” isn’t always the correct way to go. And they wonder why MRSA is on in the increase!!!

By: Lisa Van Syckel

Lisa Van Syckel — Fri, 17 Aug 2007 19:14:31 +0000

Jason,

Wow….I can finally say, that I agree with you!!!!!

By: jason

jason — Fri, 17 Aug 2007 19:02:56 +0000

I will agree with the education, but if these 12+ year educated professionals are fooled with a 10 cent pen - you are seeing the wrong doctor. But in the defense of GP’s - if people are in the hospital that does tell me they are sick. Is it being overused, maybe, but in my opinion the biggest overuse of antibiotics in the history of medicine is the quinolone class. And now that cipro is generic and use is increasing, I don’t think we can blame that on the evil pharma companies can we. Almost everyone who comes into the hospital thru the ER is started on Levaquin. Then we wonder why resistance is increasing.

Again, education is the key, but there are almost too many areas to know where to start first.

Get an ID specialist in your hospital and in charge of antibiotics and you will see appropriate antibiotic utilization. Not the fault of pharma, the fault of a lack of specialists and the new wave of medicine in which they are encouraging more generalists and less specialists. Plus the overwhelmed system, no good answers. I would hope that if everyone does poorly on an antibiotic they would decrease use, but then again I would hope that the drug is really needed and N&V is the smaller issue.

By: Laurie

Laurie — Fri, 17 Aug 2007 17:42:04 +0000

Hmm, not an LPN….and yes this drug is “supposed” to be reserved for the resistant and “superbug” infections. Sadly, we are seeing it ordered as first drug in as a wide spectrum by GP’s.
Maybe more education and less marketing would stop this practice.

By: sid

sid — Fri, 17 Aug 2007 15:38:21 +0000

huh, I guess that is why we don’t use it for the common cold. It seems like that one is reserved for patients who truly need a powerful antibiotic - thanks for the impact on LPN’s though.

What else is awful to see ordered, we need to help your day out

By: Laurie

Laurie — Fri, 17 Aug 2007 03:49:31 +0000

One of the nastiest antibiotics out there! Yup, it will kill virtually every bug that a human could catch, but the patient will puke the whole time they are getting it. I HATE to see this one ordered.