Antibiotics.. are you stocking them

[justanothergunnut]

Are you stocking antibiotics and if so to what extent?

[Patriotic Sheepdog]

Yes....what do you mean by "to what extent"?


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[justanothergunnut]

By that I mean are you stocking say a 30 count bottle of 250mg Amox or do you have several courses of each of the main players? Amox, Bactrim, Cipro, Zithro, Augmentin, Doxy.

[Patriotic Sheepdog]

The reason I asked was I didn't know if you meant quantity of pills or different antibiotics, antifungals and antiviral.

I happen to have multiple types of antibiotics, some antifungals and one antiviral. Remember, it's not about the number of pills, but what is the dose. What I mean is if you have an antibiotic that is one pill fours times a day, versus one pill twice a day and both courses are let's say the same length of ten days, you see that one bottle of thirty pills gives you less than one complete dose while the other gives you one and a half doses.

Don't forget topical antibiotics, and antifungals.


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[Lowdown3]

Family just had bronchitis, think it's the junk I've had all year.

We took some Zithromax, a 5 day course with loading dose. It did nothing to solve it.

Doc gave us different antibiotics, those seemed to work.

So we have to also know the best course of action as well.

[justanothergunnut]

Good points for sure. When I would look at stocking a antibiotic I look at the suggested dosage by weight ex. 250mg or 500mg times daily 1-3 and duration 10-14 days. I call on the side of most caution so I would keep several courses of the max dosage/duration. Under normal circumstances I wouldn't throw augmentin or cipro at a upper res infection if Zithromax will work but often as ld3 noted you don't know for sure if one will work but I resist the urge to go straight for the big guns. Zithromax works awesome for me in the sinus area I know this from experience but I have augmentin in case a resistant strain is running around.

[Patriotic Sheepdog]

Just attended lecture today about antibiotic resistance. When dealing with bacterial rhinosinusitis two of the main offenders are starting to show resistance.

Resistance profiles:

[justanothergunnut]

so correct me if im reading the above data incorrectly..with influenza at least a resistance has been noted in upwards of 40% with the penicillin derived drugs which of course includes Amoxicillin though not its bigger badder brother Augmentin(AMox+clavulanic acid) but Doxycyline still shows a 98% success rate. I find it disturbing that two antibiotics that I place a fair amount of faith in fair soo poorly against Pneumonia. Macrolides of which Zithromax is included shows 30% resistance and Bactrim at 40%. I was under the impression these were front line drugs, I knew resistance was building but 30-40% is staggering. I rely pretty heavily on IV/IM Rocephin in my stocks any data on resistance to cephalosporin's... BTW thanks for the data PSD always appreciated

[Patriotic Sheepdog]

I think the data surprised a lot of people. This is a primary care conference, I'm not in primary care but decided to go anyways, and this guy talks nationally about this topic. Nothing came out that ceftriaxone was ineffective.

Look what's happening with Urinary E.coli.....



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[justanothergunnut]

thumbnail is too small PSD even downloading and enlarging its unreadable.. We discussed previously about using a 2g Rocephin dose in either a single 2gram slam or two 1g doses followed by cipro course for 10-14 days.. In light of what this conference covered do you believe this is still a good course of action for serious life threatening events???

[Patriotic Sheepdog]

I guess you need to know what "bug" you're trying to cover. In 2000 Ciprofloxacin was showing a resistance rate of 1.2% for urinary E.coli. In 2010 it increased to 7.1% in over a half million isolates for urinary E.coli.

But, if you look at the H.flu isolates, fluoroquinolones seem to do well.

Bottom line, I store ciprofloxacin and will continues to stock it. But it won't be my first choice for a recurrent UTI. In a SHTF situation I would use it first line as it still works 93% of the time. If the patient wasn't improving within about three days, I would add an additional drug.


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[1Admin]

Having seen the effects of pneumonia on old people now, do you think it's worth getting the vaccine?

Also, FWIW, they are now saying people should get TDAP as a booster every 10 years?

[Patriotic Sheepdog]

Having seen the effects of pneumonia on old people now, do you think it's worth getting the vaccine?

Also, FWIW, they are now saying people should get TDAP as a booster every 10 years?

Pneumonia, yes for immune compromised and the elderly. The disease can have a devastating effect on this population.

TDAP:

http://www.cdc.gov/vaccines/schedules/hcp/imz/adult-shell.html

I haven't heard every 10 years except for tetanus.


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[justanothergunnut]

lets continue this PSD.. so many in our community are starting to stock fish meds. Usually amox, peni and cipro with no real idea of the effectivness of these antibiotics. Especially against resistant strains. I know it has been hammered on time and time again but do you think that a simple three drug mix may be a good idea.. say Augmentin, zithromax and cipro or augmentin, doxy, and cipro??? I think people would be well served on limited budgets and availability to stick to a few common broad spectrum meds and learn what to do with each.. What say you???

[Patriotic Sheepdog]

lets continue this PSD.. so many in our community are starting to stock fish meds. Usually amox, peni and cipro with no real idea of the effectivness of these antibiotics. Especially against resistant strains. I know it has been hammered on time and time again but do you think that a simple three drug mix may be a good idea.. say Augmentin, zithromax and cipro or augmentin, doxy, and cipro??? I think people would be well served on limited budgets and availability to stick to a few common broad spectrum meds and learn what to do with each.. What say you???

Wow, I'll have to put something together to answer this as it's not just a 1-2 sentence answer. I'm at work now.


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