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Antibiotics and the River Styx

 

skeleton to styx

 

Just try to get a post-surgery antibiotic. It’s easier to cross the River Styx.

I understand the reasoning behind the notion of “antibiotic stewardship” and being careful about prescribing antibiotics for viruses. Any sensible person would agree that antibiotics shouldn’t be given if the patient can recover without them. But who bothers to see if the patient really recovers or just develops some other malady.

The Center for Disease Control (CDC) defines antibiotic stewardship as follows:

…the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing and use is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance.*

But here’s the thing. The list of conditions patients are supposed to recover from without antibiotics goes far beyond the common cold. Even the CDC recognizes that stewardship shouldn’t be locked in to a checklist:

CDC recognizes that there is no “one size fits all” approach to optimize antibiotic use for all settings. The complexity of medical decision-making surrounding antibiotic use and the variability in facility size and types of care in U.S. healthcare settings require flexible programs and activities.*

That being the case, please tell me why surgeons refuse to give surgical patients antibiotics after procedures. Maybe some do, but my experience is that after every surgery my husband has undergone, he has developed raging infections which require antibiotics. I haven’t observed much flexibility here.

Every time my post-surgical husband is being swept out the outpatient surgery center, I ask for antibiotics, knowing he will be developing an infection. Indeed, he gets infections from colonoscopies. Obviously he’s going to get infections from cutting into his body and rearranging body parts. The response? No antibiotics. The response is just “take Tylenol.”

I do not personally know any surgeons, so I do not know if this is the standard of care on the part of surgeons, whether this is a regional habit, or whether the bean counters in corporate surgical centers fine surgeons for prescribing antibiotics after surgeries. About all I can see is this keeps the state’s tracking of antibiotic prescriptions by surgeon very short.

At the same time I can also tell you that my physician husband has many post-surgery patients show up in his clinic with infections from their surgeries done elsewhere. If he calls the surgeons, they insist the patient left the hospital without an infection. Considering how little time some surgical patients spend in the surgery centers, it is no surprise the patients leave the facility “without infection.” Doesn’t in any way absolve the surgeon of being the person responsible for a procedure which eventually develops infection.

And then there’s nursing homes where the government will no longer pay for urinary tract infection (UTI) testing, as if no testing verifies there’s no UTI. It’s certainly true that many nursing home patients have chronic UTIs, but left untreated, residents can become unpleasant to deal with. Sudden unpleasant behavior in the elderly is often a sign of illness. So caretakers that are pinched by normally pleasant old ladies get offended and file code pink reports but leave the underlying cause unaddressed. Actually, it’s easier to get a fentanyl patch to obtund the disagreeable residents than it is to test and treat for a UTI. Until, of course, the UTI becomes septic and the patient winds up in the hospital, or dead.

The River Styx has become an unholy stream encircling our health care system. Some would say Charon has just about completed rowing his boat with our current health care system to the other side.

 

 

 

Reference:

*Core Elements of Antibiotic Stewardship. CDC. <https://www.cdc.gov/antibiotic-use/core-elements/index.html>

Photo credit: ©Mahroch, Dreamstime.

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