Opinion On Antibiotics (Sqad)

[pixie373]

And anyone who cares to join in...

We have male 90 year old client. Enlarged prostate, so bladder doesn't empty properly. He is catheterised, but has constant UTIs. His doctor hates giving antibiotics (we'll all be immune to them in a few years). I do see his point, but he is giving our client trimethoprim (300mg?) for 7 days every 3 weeks. As this doesn't make any difference to him, we called out-of-hours a couple of weekends ago and he was given co-amoxiclav. He was better and urine completely clear within 48 hours and no sign of further infection for 2 weeks..
His regular doctor said he should not have been given co-amoxiclav at all and for this last episode has given him trimethoprim again. He has been taking it for five days now and urine still cloudy and sludgy.
Obviously, we can only give what doctor prescribed, but am interested what treatment you would give? Bladder washouts once a month too, now.
thank you!

[Old_Geezer]

Not qualified to answer the OP but reading it I do wonder who folk are saving the antibiotics for. Is tomorrow's patient more important than today's ? Exactly how much longer do they remain effective if they are withheld today rather than prescribed ? Roll on the next 'breakthrough'.

[pixie373]

Hi og. I may well be corrected on this, but my client said his doctor says no new antibiotics have been found since 1958.(?). I do agree though, that if there is one that we know works, he should be offered it. Also not sure of the logic if he is being given an antibiotic anyway. Is it better to for trimethoprim to be ineffective, than for co-amoxiclav to be ineffective?

[Sqad]

\\\\\ I may well be corrected on this, but my client said his doctor says no new antibiotics have been found since 1958\\\

That is nonsense.

\\\\Is it better to for trimethoprim to be ineffective, than for co-amoxiclav to be ineffective?\\\

Thar statement has lost me completely.

[LazyGun]

Well "saving the antibiotics" is very important, O_G.

There is a very strong argument to say we have been very careless with their use, over-presribing them to both humans and domesticated animals, like cattle. The consequence of such over use is that many of the bacteria have developed antibiotic resistance. This is not just a problem for the future; It effects many people, particularly post-operative or elderly or immunocompromised patients right now.

Not sure exactly when the last antibiotic was found, but it was certainly some decades ago. We have been making do with variations on a theme within the different well established classes of antibiotics, and using a cocktail of antibiotics for a long time now, and there is very little evidence of new antibiotics in the development pipeline. This is a worrying circumstance.

There are some new approaches to treating infection and killing bacteria - use of phages for instance- viruses tailored to kill specific bacteria - but these are a very long way from being commercially available.

[pixie373]

Ok. So there have been new types of antibiotics found more recently?

My second statement meant that the doctor won't give co-amoxiclav, in case it becomes ineffective (immune), but he will give trimethoprim, which is still an antibiotic. So I gather he has no objection to trimethoprim becoming ineffective. Why would that be?

[pixie373]

Sorry, lg. Posted before i saw yours