Talk:Antibiotic: Difference between revisions

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Why won't WP flag go away?  There are only a few lines that Robert Badgett wrote for WP, so we don't really need it.  I will be re-writing anyway to be more generic for those 2-3 sentences. [[User:David E. Volk|David E. Volk]] 14:28, 11 July 2008 (CDT)
 
'''This section was removed from Main Page''' by [[User:David E. Volk|David E. Volk]]
==Misuse==
One study on [[respiratory tract infection]]s found "physicians were more likely to prescribe antibiotics to patients who they believed expected them, although they correctly identified only about 1 in 4 of those patients".<ref name="pmid17467120">{{cite journal |author=Ong S, Nakase J, Moran GJ, Karras DJ, Kuehnert MJ, Talan DA |title=Antibiotic use for emergency department patients with upper respiratory infections: prescribing practices, patient expectations, and patient satisfaction |journal=Annals of emergency medicine |volume=50 |issue=3 |pages=213-20 |year=2007 |pmid=17467120 |doi=10.1016/j.annemergmed.2007.03.026}}</ref> Multifactorial interventions aimed at both physicians and patients can reduce inappropriate prescribing of antibiotics. <ref name="pmid17509729">{{cite journal |author=Metlay JP, Camargo CA, MacKenzie T, ''et al'' |title=Cluster-randomized trial to improve antibiotic use for adults with acute respiratory infections treated in emergency departments |journal=Annals of emergency medicine |volume=50 |issue=3 |pages=221-30 |year=2007 |pmid=17509729 |doi=10.1016/j.annemergmed.2007.03.022}}</ref> Delaying antibiotics for 48 hours while observing for spontaneous resolution of [[respiratory tract infection]]s may reduce antibiotic usage; however, this strategy may reduce patient satisfaction.<ref name="pmid17636757">{{cite journal |author=Spurling G, Del Mar C, Dooley L, Foxlee R |title=Delayed antibiotics for respiratory infections |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3 |pages=CD004417 |year=2007 |pmid=17636757 |doi=10.1002/14651858.CD004417.pub3}}</ref>
 
Robert, I find this section to be rather technical without really giving much information, so I would like to rewrite it.
I have removed the from WP tag, as no information from WP is still present, and I would like to remove any WP tag from such a large article if at all possible.  Let's try and make this article a fully CZ original.
 
: I restored an edited version of this to the resistance section. Feel free to edit further. - Bob - [[User:Robert Badgett|Robert Badgett]] 15:04, 6 March 2009 (UTC)
 
== Ready for Approval? ==
Does this look ready for approval to any of the medical editors? If not, any suggestions for what is needed? [[User:David E. Volk|David E. Volk]] 17:20, 13 March 2009 (UTC)
 
:As a start, both the lede needs to mention that antibiotic choice is an issue and mention some of the considerations.  The lede might have a list or table of classes, and then follow with typical uses by class. Before getting into the molecular pharmacology, a general reader might ask "what kind of antibiotic is good for (fairly easy) ''Streptococcus'' and (hard) ''Staphylococcus''?  Some discussion of appropriate and inappropriate empirical use is in order, such as situations where no culture is available or in fulminant illness while awaiting the lab results, or, in contrast, antibiotics for the common cold. Consider a general antibiotogram-style table of class vs. disease/organism type. [[User:Howard C. Berkowitz|Howard C. Berkowitz]] 18:32, 13 March 2009 (UTC)
 
::These are good ideas, best done by an MD I think. Writing about which bacteria they HAVE been used for, vs RECOMMENDING a particular choice, seems to be "practicing medicine", as the best choice is constantly changing.
Perhaps Robert can write some of your suggestions. [[User:David E. Volk|David E. Volk]] 14:51, 14 March 2009 (UTC)
 
::In fact, a [[clinical decisison support system]] has a specific role in what many call an "antibiotogram".  Even where there are general receommendations, especially with hospital-acquired infections, and in certain community acquired infections, there has to be continuing aggregate chart (and infection control review) to determine the first-choice antibiotics for that location and that time. As a hypothetical example, resistance patterns in one area might show that a [[fluoroquinolone]] is more likely, in a given population or geographic example, to be a better first choice than a cephalosporin for [[cellulitis]] when no culture is available. There are places where [[spectinomycin]] is still a useful second-choice drug reserved for ''Neisseria gonorrheae,'' and others where there's so much resistance where it should not be considered.   
 
::Still, there are several references that do provide overall first, second, and third line choices. In other cases, one needs a CDSS or a hospital-printed reference to decide a more expensive subclass of fluoroquinolones )e.g., gatofloxacin vs. ciprofloxacin) is justified for community-acquired pneumonia. [[User:Howard C. Berkowitz|Howard C. Berkowitz]] 16:36, 14 March 2009 (UTC)
 
== Antibiotic induced illnesses ==
Perhaps someone could add a section of illnesses typically tied to the use of antibiotics.  For example, using medium strength antibiotics may let C. Diff go nuts, causing ulcerations, Crohn's or some such thing.  It seems to be an important topic that might make people think twice about always requesting antibiotics. [[User:David E. Volk|David E. Volk]] 15:35, 20 June 2009 (UTC)
 
== Lede, definition: not just bacteria ==
 
This still needs work, but antibiotics cover more than bacteria. If one thinks of an antibiotic as microorganism-derived or at least synthesized on a class coming from them, there are still antifungals, antiprotozoals, and antitumor agents. The lede mentions antivirals, which, at least of the HAART drugs, are purely synthetic. --[[User:Howard C. Berkowitz|Howard C. Berkowitz]] 04:48, 31 January 2010 (UTC)

Latest revision as of 22:48, 30 January 2010

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 Definition:  Drugs that reduce the growth or reproduction of bacteria. [d] [e]
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This section was removed from Main Page by David E. Volk

Misuse

One study on respiratory tract infections found "physicians were more likely to prescribe antibiotics to patients who they believed expected them, although they correctly identified only about 1 in 4 of those patients".[1] Multifactorial interventions aimed at both physicians and patients can reduce inappropriate prescribing of antibiotics. [2] Delaying antibiotics for 48 hours while observing for spontaneous resolution of respiratory tract infections may reduce antibiotic usage; however, this strategy may reduce patient satisfaction.[3]

Robert, I find this section to be rather technical without really giving much information, so I would like to rewrite it. I have removed the from WP tag, as no information from WP is still present, and I would like to remove any WP tag from such a large article if at all possible. Let's try and make this article a fully CZ original.

I restored an edited version of this to the resistance section. Feel free to edit further. - Bob - Robert Badgett 15:04, 6 March 2009 (UTC)

Ready for Approval?

Does this look ready for approval to any of the medical editors? If not, any suggestions for what is needed? David E. Volk 17:20, 13 March 2009 (UTC)

As a start, both the lede needs to mention that antibiotic choice is an issue and mention some of the considerations. The lede might have a list or table of classes, and then follow with typical uses by class. Before getting into the molecular pharmacology, a general reader might ask "what kind of antibiotic is good for (fairly easy) Streptococcus and (hard) Staphylococcus? Some discussion of appropriate and inappropriate empirical use is in order, such as situations where no culture is available or in fulminant illness while awaiting the lab results, or, in contrast, antibiotics for the common cold. Consider a general antibiotogram-style table of class vs. disease/organism type. Howard C. Berkowitz 18:32, 13 March 2009 (UTC)
These are good ideas, best done by an MD I think. Writing about which bacteria they HAVE been used for, vs RECOMMENDING a particular choice, seems to be "practicing medicine", as the best choice is constantly changing.

Perhaps Robert can write some of your suggestions. David E. Volk 14:51, 14 March 2009 (UTC)

In fact, a clinical decisison support system has a specific role in what many call an "antibiotogram". Even where there are general receommendations, especially with hospital-acquired infections, and in certain community acquired infections, there has to be continuing aggregate chart (and infection control review) to determine the first-choice antibiotics for that location and that time. As a hypothetical example, resistance patterns in one area might show that a fluoroquinolone is more likely, in a given population or geographic example, to be a better first choice than a cephalosporin for cellulitis when no culture is available. There are places where spectinomycin is still a useful second-choice drug reserved for Neisseria gonorrheae, and others where there's so much resistance where it should not be considered.
Still, there are several references that do provide overall first, second, and third line choices. In other cases, one needs a CDSS or a hospital-printed reference to decide a more expensive subclass of fluoroquinolones )e.g., gatofloxacin vs. ciprofloxacin) is justified for community-acquired pneumonia. Howard C. Berkowitz 16:36, 14 March 2009 (UTC)

Antibiotic induced illnesses

Perhaps someone could add a section of illnesses typically tied to the use of antibiotics. For example, using medium strength antibiotics may let C. Diff go nuts, causing ulcerations, Crohn's or some such thing. It seems to be an important topic that might make people think twice about always requesting antibiotics. David E. Volk 15:35, 20 June 2009 (UTC)

Lede, definition: not just bacteria

This still needs work, but antibiotics cover more than bacteria. If one thinks of an antibiotic as microorganism-derived or at least synthesized on a class coming from them, there are still antifungals, antiprotozoals, and antitumor agents. The lede mentions antivirals, which, at least of the HAART drugs, are purely synthetic. --Howard C. Berkowitz 04:48, 31 January 2010 (UTC)

  1. ↑ Ong S, Nakase J, Moran GJ, Karras DJ, Kuehnert MJ, Talan DA (2007). "Antibiotic use for emergency department patients with upper respiratory infections: prescribing practices, patient expectations, and patient satisfaction". Annals of emergency medicine 50 (3): 213-20. DOI:10.1016/j.annemergmed.2007.03.026. PMID 17467120. Research Blogging.
  2. ↑ Metlay JP, Camargo CA, MacKenzie T, et al (2007). "Cluster-randomized trial to improve antibiotic use for adults with acute respiratory infections treated in emergency departments". Annals of emergency medicine 50 (3): 221-30. DOI:10.1016/j.annemergmed.2007.03.022. PMID 17509729. Research Blogging.
  3. ↑ Spurling G, Del Mar C, Dooley L, Foxlee R (2007). "Delayed antibiotics for respiratory infections". Cochrane database of systematic reviews (Online) (3): CD004417. DOI:10.1002/14651858.CD004417.pub3. PMID 17636757. Research Blogging.
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