Thursday, February 9, 2017

#12 Antibiotics: Tell Your Doc if They Aren't Working

Dear Dr. Tumoriffic,

I took my entire course of antibiotics, but my pneumonia is still not better. What should I do?


Mr. Cofflin

Dear Mr. Cofflin,

Clearly, you were taking your antibiotic  incorrectly. Much like a fine wine, antibiotics must be paired with the right food.

For instance, you should never pair amoxicillin with red meat. The food will overwhelm the flavor. Amoxicillin goes better with subtle flavors such as a buttered white fish like flounder or sole. You would be advised to wash it down with a pinot grigio or sauvignon blanc.

On the other hand, a bold antibiotic, such as levofloxacin (aka, Levaquin) can be paired with a bold flavor such as grilled sirloin or pasta marinara. Here, you should take your tablets with chianti or red zinfandel.

Azithromycin (commonly found in the Z-pack) is a fine every-day pill. You should take with ale and a hamburger.  Whereas doxycycline is for hard alcohol and beef jerky.

No. Scratch all that. Booze and pills don't mix well.

Most of the time, your antibiotic should make you feel mostly better within 3-5 days. If it does not, or if your infection is worse after 2-3 days, you're on the wrong pill. Also, if your antibiotic is making you projectile vomit or is showing up undigested in your poop, those are also a bad signals.

Surprisingly, I and other doctors sometimes get it wrong. For most respiratory infections outside of the hospital, at least, treatment is based on guesswork. *  It's hard to get a proper culture to identify the exact germ responsible for the infection, and we can usually do pretty well just by knowing which bugs are common the area and which antibiotics tend to work for them.

So what to do then? Give up on antibiotic entirely and go to your local faith healer.

No. First of all, don't just stop the antibiotic without talking to your doctor. Call your doctor. Tell them what's going on so they can replace the antibiotic with one that works better.

I have seen this several times in the last few weeks, and it makes me afraid for my patients. They have come to me much sicker weeks after they finished their prescriptions. (I suspect there is an unusual bug in my community.) One of these days, someone is going to wait too long for the antibiotics to work and they'll get really sick. Now, I'm trying harder to explain this to them.

When you take an antibiotic, most of the bacteria should be killed off in the first few days. You shouldn't stop early, because the rest of the course of antibiotic kills off the stragglers. But if the initial attack is unsuccessful, the bugs are just going to get stronger. Talk to your doctor.

Be well,

Dr. Tumoriffic

* For urinary tract infections, we usually get a culture, so even if we guess wrong to begin with, we can quickly correct our course. However, sometimes, even antibiotics that appear to be effective in culture turn out not to be in real life. That's a whole other subject.

Adorable Sea Otters

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