NationStates Jolt Archive

So, I've got myself a nasty case of tonsillitis. I've been to the doc a couple of times, and am not seeking personal medical info, but rather general.

First time in, the doc gave me a three day script of antibiotics. Today he started to give me anothe three day script. I asked him for a seven day script. He said "In the last 10-15 years thinking on antibiotics has changed and three day courses are the usual."

Hmmm.... medical types, is this straight up?

So, I've got myself a nasty case of tonsillitis. I've been to the doc a couple of times, and am not seeking personal medical info, but rather general.

First time in, the doc gave me a three day script of antibiotics. Today he started to give me anothe three day script. I asked him for a seven day script. He said "In the last 10-15 years thinking on antibiotics has changed and three day courses are the usual."

Hmmm.... medical types, is this straight up?

I guess it may depend on where in the world you are. Over here in the UK a week's dose is the norm, depending of course on the severity of the illness.

Looks like a sure way to create resistant germs to me.

of course it normal now what with antibiotics being rather valuable

however 3 days is weird but then again its tonsillitis ffs what are you even doing at the doctors?

I'd have thought it would be better to give a prescription that outlasts the infection than one that might not; on account the bugs might develop resistance if you give them a chance to recover.

of course it normal now what with antibiotics being rather valuable

however 3 days is weird but then again its tonsillitis ffs what are you even doing at the doctors?

Why the doc? 'Cause at ten days I know this infection ain't going away by itself.

Plus, I want to avoid the nastier complications.

Why the doc? 'Cause at ten days I know this infection ain't going away by itself.

Plus, I want to avoid the nastier complications.

odds are the doctor is just trying to get rid off you, I suggest a healthy dose of TLC and suffering on in the thought that your body can actually deal with such things unless it starts to lose

then again this is the drop-out army medic talking :p

I had a sore throat for 3 weeks during January. I really don't like using antibiotics unless it's totally necessary. The Quacks here are far too pill-dispensing-happy, which is why HK has some of the most antibiotic-resistant strains on Earth.
So I went to a Chinese Herbal Doctor and Acupuncturist instead. He gave me a bag of herbs which I boiled into tea. Two bags, two days and I was right as rain. Not only was the throat good and proper fixed, but I also felt full of energy for first time in ages. Made me a believer.

I had a sore throat for 3 weeks during January. I really don't like using antibiotics unless it's totally necessary. The Quacks here are far too pill-dispensing-happy, which is why HK has some of the most antibiotic-resistant strains on Earth.
So I went to a Chinese Herbal Doctor and Acupuncturist instead. He gave me a bag of herbs which I boiled into tea. Two bags, two days and I was right as rain. Not only was the throat good and proper fixed, but I also felt full of energy for first time in ages. Made me a believer.

was it some marijuana? it always has that effect on me when I smoke A bag a day:D

odds are the doctor is just trying to get rid off you, I suggest a healthy dose of TLC and suffering on in the thought that your body can actually deal with such things unless it starts to lose

then again this is the drop-out army medic talking :p

Well, this is my regular asthma doc, so he's not likely wanting to get rid of me...

I had a sore throat for 3 weeks during January. I really don't like using antibiotics unless it's totally necessary. The Quacks here are far too pill-dispensing-happy, which is why HK has some of the most antibiotic-resistant strains on Earth.
So I went to a Chinese Herbal Doctor and Acupuncturist instead. He gave me a bag of herbs which I boiled into tea. Two bags, two days and I was right as rain. Not only was the throat good and proper fixed, but I also felt full of energy for first time in ages. Made me a believer.

I tend to dislike the J doc's attitude of "It's a cold! Hit it with a short course of antibiotics!" But, I'm up enough to say "hey, it looks bacterial, give me a full course...."

And my doc does the Chinese "kampo" thing on top of the western meds. I've got a nasty Chinese powder to take along with the antibiotics. Bleachk!

Well, I'm only a medico-in-training but maybe I can help.

In the past couple of decades, the medical community at large has gotten wise of bacterial antibiotic resistance, and realized that they themselves may have been to blame for the massive growth of resistant and tolerant strains.

An antibiotic will wipe out an infection for sure, but if you have a resistant bug, then it'll survive to repopulate, and you'll wind up with an infection that's resistant to one or more antimicrobials.

For quite some time, antibiotics were wonder drugs, prescribed for just about everything, even the smallest of infections. And we would use the strongest new antibiotic available before considering using an older one.

The result was that many of most common bugs were becoming resistant to even the strongest antibiotics; the massive daily antibiotic use worldwide was literally inducing genetic mutations in bacteria, leading to the resistant strains we have today. We thought that the days of dying of pneumonia were over, but now you can wind up with a bug that's resistant to our strongest antimicrobial.

And today, we're much more judicious about antibiotic use then before, and we have a very strict scale on how we use them: we use the weakest antibiotics first, then slowly proceed upward, and always in smaller doses

Hope that helped.

was it some marijuana? it always has that effect on me when I smoke A bag a day:D

LOL.

I sure wish I could swing a medical cannabis script for my asthma (it's a good bronchodilator).

Well, I'm only a medico-in-training but maybe I can help.

In the past couple of decades, the medical community at large has gotten wise of bacterial antibiotic resistance, and realized that they themselves may have been to blame for the massive growth of resistant and tolerant strains.

An antibiotic will wipe out an infection for sure, but if you have a resistant bug, then it'll survive to repopulate, and you'll wind up with an infection that's resistant to one or more antimicrobials.

For quite some time, antibiotics were wonder drugs, prescribed for just about everything, even the smallest of infections. And we would use the strongest new antibiotic available before considering using an older one.

The result was that many of most common bugs were becoming resistant to even the strongest antibiotics; the massive daily antibiotic use worldwide was literally inducing genetic mutations in bacteria, leading to the resistant strains we have today. We thought that the days of dying of pneumonia were over, but now you can wind up with a bug that's resistant to our strongest antimicrobial.

And today, we're much more judicious about antibiotic use then before, and we have a very strict scale on how we use them: we use the weakest antibiotics first, then slowly proceed upward, and always in smaller doses

Hope that helped.

Indeed. Thanks.

Indeed. Thanks.

You're welcome.

Not that I'd necessarily suggest that anyone suffer needlessly from an infection when an antibiotic is available to wipe it out, but precautions, especially today, need to be taken.

It's sort of why the world was so worried (not to mention pissed off) when we heard that there was one guy who was knowingly flying around the world with a resistant strain of Tuberculosis.

What an ass. :p

LOL.

I sure wish I could swing a medical cannabis script for my asthma (it's a good bronchodilator).

So do I. actually thats how my friend justifies it.
my friend "I hurt my toe. Wanna go buy a dime bag?"
me "get in the car, I'll pay for it."
him "sweet were gettin some pakololo"
:D

You're welcome.

Not that I'd necessarily suggest that anyone suffer needlessly from an infection when an antibiotic is available to wipe it out, but precautions, especially today, need to be taken.

It's sort of why the world was so worried (not to mention pissed off) when we heard that there was one guy who was knowingly flying around the world with a resistant strain of Tuberculosis.

What an ass. :p

I concur.

Well, I'm only a medico-in-training but maybe I can help.

In the past couple of decades, the medical community at large has gotten wise of bacterial antibiotic resistance, and realized that they themselves may have been to blame for the massive growth of resistant and tolerant strains.

An antibiotic will wipe out an infection for sure, but if you have a resistant bug, then it'll survive to repopulate, and you'll wind up with an infection that's resistant to one or more antimicrobials.

For quite some time, antibiotics were wonder drugs, prescribed for just about everything, even the smallest of infections. And we would use the strongest new antibiotic available before considering using an older one.

The result was that many of most common bugs were becoming resistant to even the strongest antibiotics; the massive daily antibiotic use worldwide was literally inducing genetic mutations in bacteria, leading to the resistant strains we have today. We thought that the days of dying of pneumonia were over, but now you can wind up with a bug that's resistant to our strongest antimicrobial.

And today, we're much more judicious about antibiotic use then before, and we have a very strict scale on how we use them: we use the weakest antibiotics first, then slowly proceed upward, and always in smaller doses

Hope that helped.How come my doctor never told me this? I've been on antibiotics for YEARS IN A ROW.

Hmmm.... medical types, is this straight up?

It sounds quite kooky, actually. The regular treatment for bacterial tonsillitis in adults here is Penicillin V 1g two/three* times a day for ten days as that is the time usually required to eradicate the pathogen (most commonly a streptococcus, but can be staphylococcus or even such oddities as corynebacterium diphteriae depending on country). This whole "three days at a time" sounds very nonsensical from a resistance point of view and annoying for both patient and doctor.

*Three times a day gives microbiologically more even serum concentrations and can thus theoretically be more advantageous in not selecting for resistant strains, but hasn't shown to have more practical benefits than two times a day. We are however lucky in Sweden to still have a benign flora so that we in these cases actually can use "regular" penicillin instead of having to resort to other antibiotics (e.g. erythromycin, cephalosporins, tetracyclines...) as drugs of first choice.

It sounds quite kooky, actually. The regular treatment for bacterial tonsillitis in adults here is Penicillin V 1g two/three* times a day for ten days as that is the time usually required to eradicate the pathogen (most commonly a streptococcus, but can be staphylococcus or even such oddities as corynebacterium diphteriae depending on country). This whole "three days at a time" sounds very nonsensical from a resistance point of view and annoying for both patient and doctor.

*Three times a day gives microbiologically more even serum concentrations and can thus theoretically be more advantageous in not selecting for resistant strains, but hasn't shown to have more practical benefits than two times a day. We are however lucky in Sweden to still have a benign flora so that we in these cases actually can use "regular" penicillin instead of having to resort to other antibiotics (e.g. erythromycin, cephalosporins, tetracyclines...) as drugs of first choice.

Perhaps a ploy to get a patient back in, hence another office visit fee (depending on where in the world they are)? Or for some reason the doctor wishes to keep a close eye on this particular infection?

Perhaps a ploy to get a patient back in, hence another office visit fee (depending on where in the world they are)? Or for some reason the doctor wishes to keep a close eye on this particular infection?

Or it could just be a bureaucratic muck-up. They could've become set in their ways, not willing to change even if they know that this particular dosage doesn't do anything, or benefit anyone. 3 a day just may be the "standard" regardless of the pathogen, the severity of the disease, or the patient.

Considering how slow some medical institutions can be, it's a possibility. I don't know much about Japan's medical institutions however, so my jaded self may be mistaken.

The former would be unethical, the latter (while improbable, since if it looked so serious as to need such close monitoring is not a case for a GP, but for an ENT specialist) should be clearly communicated to the patient so (s)he knows why they're made to come back and shouldn't lead to additional costs.

So it's a bureaucratic upfuckery...?

BTW Fass, what is your profession in medical? I'm training (or will be training...still in the basics) to be a nurse.

Perhaps a ploy to get a patient back in, hence another office visit fee (depending on where in the world they are)? Or for some reason the doctor wishes to keep a close eye on this particular infection?

The former would be unethical, the latter (while improbable, since if it looked so serious as to need such close monitoring is not a case for a GP, but for an ENT specialist) should be clearly communicated to the patient so (s)he knows why they're made to come back and shouldn't lead to additional costs.

I have had the same infection for years. Is there any chance my antibiotics aren't making it worse? I'm already badly scarred.

Don't look for medical advice here, that's a bad idea.
Well, I figured it was worth a shot asking the internet since I've been to a lot of dermatologists and none of them have solved the problem yet.

So it's a bureaucratic upfuckery...?

I don't know what it is apart from seemingly bonkers, but that's just speculation on my part as I have no idea how the reasoning goes in Japan.

BTW Fass, what is your profession in medical? I'm training (or will be training...still in the basics) to be a nurse.

I have three more months to go before I graduate from med school. Our system is completely different from the one in the USA (which I seem to recall you being from for some reason), but a very gross time equivalent would be "intern".

I have had the same infection for years. Is there any chance my antibiotics aren't making it worse? I'm already badly scarred.

Don't look for medical advice here, that's a bad idea.

I have had the same infection for years. Is there any chance my antibiotics aren't making it worse? I'm already badly scarred.

What?!

Have you been seeing the same doctor for all that time?!

Well, I figured it was worth a shot asking the internet since I've been to a lot of dermatologists and none of them have solved the problem yet.

And we who cannot see your condition, and cannot have any insight into what caused it and the treatment motivations are supposed to be able to tell you better? I don't mean that as hostile, I'm just stating a fact. In any case, this isn't possibly some form of acne you're talking about?

What?!

Have you been seeing the same doctor for all that time?!No.
And we who cannot see your condition, and cannot have any insight into what caused it and the treatment motivations are supposed to be able to tell you better? I don't mean that as hostile, I'm just stating a fact. In any case, this isn't possibly some form of acne you're talking about?It seems like acne, but the bumps are larger and last longer.

I have three more months to go before I graduate from med school. Our system is completely different from the one in the USA (which I seem to recall you being from for some reason), but a very gross time equivalent would be "intern".

Fair enough.

It seems like acne, but the bumps are larger and last longer.

Cystic acne?

I have three more months to go before I graduate from med school. Our system is completely different from the one in the USA (which I seem to recall you being from for some reason), but a very gross time equivalent would be "intern".

congratulations in advance!

when you graduate are you required to have further training before you are fully qualified as a doctor?

congratulations in advance!

Thank you.

when you graduate are you required to have further training before you are fully qualified as a doctor?

I am allowed to work as a doctor and prescribe medication only to patients at the clinic where I am employed, which is what I will be doing for six months as a sort of "break". To gain my licence, and thus get general prescription rights and qualify for specialisation and to climb the career ladder, I need to finish a 21 month "AT" service, which is a rotating form of employment between surgery, internal medicine, primary care, psychiatry and some others, the whole lot being heavily focused on emergency medicine. Once that's done there is an AT exam to be passed, and as I said it's time to pick a speciality.

It sounds quite kooky, actually. The regular treatment for bacterial tonsillitis in adults here is Penicillin V 1g two/three* times a day for ten days as that is the time usually required to eradicate the pathogen (most commonly a streptococcus, but can be staphylococcus or even such oddities as corynebacterium diphteriae depending on country). This whole "three days at a time" sounds very nonsensical from a resistance point of view and annoying for both patient and doctor.

*Three times a day gives microbiologically more even serum concentrations and can thus theoretically be more advantageous in not selecting for resistant strains, but hasn't shown to have more practical benefits than two times a day. We are however lucky in Sweden to still have a benign flora so that we in these cases actually can use "regular" penicillin instead of having to resort to other antibiotics (e.g. erythromycin, cephalosporins, tetracyclines...) as drugs of first choice.

Thank you. I was suspicious when he handed out the 3 day script. Japanese doctors tend towards handing out antibiotics like candy in my experience. Part of it is due to the health ministry's stupid regulations. (A fine example is dental hygene - a cleaning that would be one visit in the US requires 6 visits in Japan simply due to govt. regs.)

Seven days is normal for strep infections (the common cause of tonsillitis) here, but I've been known to wait long enough that I get a 10 day course of antibiotics.

What antibiotic are you on? azithromycin comes in a three- and one-day dose

What antibiotic are you on? azithromycin comes in a three- and one-day dose

That's mainly for VD, Sarky... you naughty, boy, you.

That's mainly for VD, Sarky... you naughty, boy, you.

haha...also great for bronchitis ;)

haha...also great for bronchitis ;)

Of course, but it's not first choice and IIRC is usually given in one large dose the first day, and smaller doses for an additional three-four days. (Damned fass.se refuses to load! How ironic.)

What antibiotic are you on? azithromycin comes in a three- and one-day dose

Oral Levofloxacin, 3x a day

That's mainly for VD, Sarky... you naughty, boy, you.

Oddly enough, pharyngeal Gonorrhea is a VD of concern here in Japan.

Of course, but it's not first choice and IIRC is usually given in one large dose the first day, and smaller doses for an additional three-four days. (Damned fass.se refuses to load! How ironic.)

The original dose, iirc, was two pills the first day, then one for the following four days (atleast here)...more recent dosages were the two pills then two days of one pill, and, most recent, a one time liquid dosage (banana-strawberry flavor...how disgusting). If I remember what dad told me correctly, it wasn't originally approved for one time dose because patients were complaining the second day that they didn't feel better. I'm not sure why that has changed.

I tend to have a constant stock of the stuff, along with Amox/K clav and cephalexin, each for their various reasons...easier to just keep a stock of them than have to deal with the pharmacy. Doesn't hurt that I still get my z pak for free

Oral Levofloxacin, 3x a day

For tonsillitis? That's... odd.

Oddly enough, pharyngeal Gonorrhea is a VD of concern here in Japan.

As an isolated, persistent site of infection?

For tonsillitis? That's... odd.

Hmmm... did I pick up the wrong name for Cravit? Looking around it seems not to be an odd choice...

As an isolated, persistent site of infection?

Sex workers...

Hmmm... did I pick up the wrong name for Cravit? Looking around it seems not to be an odd choice...

Cravit seems to be levofloxacin, but it is usually reserved for usage in upper urinary tract infections, atypical pneumonias, COPD exacerbations, skin infections... not tonsillitis, because while it is active against streptococcus pyogenes (the most common cause of bacterial tonsillitis), it is overkill. Here fluoroquinolones (the group of antibiotics that levofloxacin belongs to) are subject to a national "usage strategy" and their usage for trivial infections is heavily discouraged.

Sex workers...

But, they should have it elsewhere and not just the throat, unless Japan has sex workers specialised in doing only blowjobs.

Cravit seems to be levofloxacin, but it is usually reserved for usage in upper urinary tract infections, atypical pneumonias, COPD exacerbations, skin infections... not tonsillitis, because while it is active against streptococcus pyogenes (the most common cause of bacterial tonsillitis), it is overkill. Here fluoroquinolones (the group of antibiotics that levofloxacin belongs to) are subject to a national "usage strategy" and their usage for trivial infections is heavily discouraged.

That may explain it. The doc switched drugs on me today.

But, they should have it elsewhere and not just the throat, unless Japan has sex workers specialised in doing only blowjobs.

Indeed Japanese sex work tends to concentrate in that field due to legalities (oral's legal while coitus isn't).

Thank you. I was suspicious when he handed out the 3 day script. Japanese doctors tend towards handing out antibiotics like candy in my experience. Part of it is due to the health ministry's stupid regulations. (A fine example is dental hygene - a cleaning that would be one visit in the US requires 6 visits in Japan simply due to govt. regs.)

Have they attempted reforms, or is this so entrenched that one would need a jackhammer to fix it?

Have they attempted reforms, or is this so entrenched that one would need a jackhammer to fix it?

Heh. Hammertime.

An example is one of my standard asthma meds, advair. It's essentially a combined delivery of two meds I've been on for years, and has been available elsewhere for a long time. But, since it's a "new" med, according to Japan's health ministry, I need to renew my script every two weeks, instead of the standard 30 days...