I agree that the Cephalazation of medicine is a major contributor
of resistant organisms, but might I point out that wanton the use of
Amoxicillin and Penicillin has also contributed to what is and will
continue to be a problem. It is known that there are areas in the
world that pen resistant strep pneumo is rampant. Spain is one
example. It is so in the U.S. also. In Texas and other states in the
south, the CDC has said there are up to 20% resistant strains. Why
should anyone care? Well, children with strep pneumo meningitis placed
on penicillin have died. There was one such child transferred to the
hospital where I did my residency in Philadelphia who, upon arrival,
was placed on Cefotaxime. Despite seemingly adequate antibiotic
therapy, the child died a few days later (his brain was a mass of pus).
At that hospital and the hospital where I am now, if a child has gram
positive cocci in the CSF, Vancomycin is used until sensitivies are
completed. Why vanco instead of Cefotax? Well even in our hospital
there have been strep pneumo isolates resistant to Cefotax. What
happens when we find organisms resistant to our biggest guns?
On a less dire note, resistant strep pneumo is a contributor to
the increase in otitis media refractory to antibiotic treatment. This
has meant more visits to the pediatrician, more lost school and work
days, increased costs, more surgeries, and more frustration. Also, it's
not difficult to imagine that a child colonized with resistant strep
pneumo could at some point become infected (maybe with meningitis) and
therein lies the problem. Of course there are other contributors to
the rising incidence of resistant strep pneumo such as daycare. There
is a plethora of literature addressing this issue. If I was in my
office I'd cite articles (April 1995 Archives of Pediatric and
Adolescent Medicine contains an article describing the incidence of
resistant strep pneumo in Washington, D.C.)
Other organisms known to be resistant to antibiotics: TB,
enterococcus, syphillis, Gonorrhea to name a few. They are out there
and inappropriate use of antibiotics is a big contributor. As
physicians we need to not only care for our individual patient, but the
public health as well so I disagree that a little amox is harmless.
Maybe for that one person, but it is possibly just one more person
colonized with resistant organisms.
I think its great that there are people standing up to drug reps.
One of my biggest pet peeves also is the COST of these new drugs. Why
treat with the Cephdajour when amoxicillin, bactrim, or pediazole are
just as good. Just adding my 2 cents, whatever it's worth.
Children's National Medical Center