Relay-Version: version B 2.10 5/3/83; site utzoo.UUCP Posting-Version: version B 2.10.2 9/18/84; site ski.UUCP Path: utzoo!watmath!clyde!burl!ulysses!bellcore!decvax!decwrl!pyramid!hplabs!qantel!ptsfa!ski!dr From: dr@ski.UUCP (David Robins) Newsgroups: net.med Subject: Re: (antibiotics) legal? Message-ID: <234@ski.UUCP> Date: Tue, 4-Mar-86 13:29:41 EST Article-I.D.: ski.234 Posted: Tue Mar 4 13:29:41 1986 Date-Received: Fri, 7-Mar-86 06:51:09 EST References: <156@proper.UUCP> <12057@ucbvax.BERKELEY.EDU> <915@felix.UUCP> <22@spdcc.UUCP> <1425@osu-eddie.UUCP> Organization: Smith-Kettlewell Institute, S.F., CA. Lines: 82 > to prescribe. The money spent for the useless drugs and office visits doesn't > bug me half as much as having non-specific urethritis for 3 months, when it > could have been fixed up in 2 weeks. > > Is there some legitimate reason why doctors will not have such a sensitivity > test performed? Most of the doctors I have gone to say that it isn't worth > the time and expense to the patient, but I have NEVER seen a case where the > correct antibiotic was prescribed the first time. > -- > < < < < < < < < < < < < < < < < < < < <> > > > > > > > > > > > > > > > > > > > > Mark D. Freeman mdf@osu-eddie.uucp > StrongPoint Systems, Inc. mdf@osu-eddie.arpa > Guest account at The Ohio State University !cbosgd!osu-eddie!mdf > > I speak, therefore I disclaim everything I say. > < < < < < < < < < < < < < < < < < < < <> > > > > > > > > > > > > > > > > > > > Non-specific urethritis is becoming more common every day, due to the fact that it is caused by an organism that is primarily sexually transmitted these days. The organism is Chlamydia. Most urethritis has a bacterial cause, such as Gonorrhea- these are reasonably easily cultured. However, since the symptoms are usually pretty clear, sometimes treatment is initiated without a culture. If there is no response, then it it time to stop antibiotics for a few days and get a culture and sensitivity to get to the root of the problem. Unfortunately, Chlamydia does NOT culture easily. It is an intra-cellular organism, of a type somewhere between bacteria and virus. It can be diagnosed by a skilled lab tech sometimes on a smear looking for Inclusion Bodies- but only if cells, rather than exudate, has been obtained. Even then, the yield is fairly low. Cultures of known Chlamydia infections only grow out about half the time, even under the best of circumstances. The average office does not have a sophisticated microbilogy laboratory next door, so culture specimens are picked up by a service. Since the organisms are rather fragile, they often die before they get to the lab. Also, there is the problem of getting cells- most men are are a bit sensitive to scraping the inside of the urethra with a metal instrument to harvest cells! Also, these organisms do not grow in the usual 24 hours that baterial cultures do. In such cases, if non-specific urethritis (NSU) is suspected after poor response to antibiotics for the presumed organism, a trial of tetracycline (the drug of choice for NSU) is given, and the symptoms may disappear, leading to a presumption that it was Chlamydia. We have the same type of problem in ophthalmology. We are seeing more and more cases of conjunctivitis with a very sticky mucus discharge. Since almost all conjunctivitis without a purulent discharge is caused by virus, and since there is no specific therapy for viral conjunctivitis, we sometimes have to wait and see if it resolves on its own. Unfortunately, that may be anywhere from 10 days to several weeks or longer. (Some doctors give various antibiotic drops, on the premise that they reduce secondary bacterial infections, and becasue patients demand antibiotics- they feel cheated if they don't walk out with a prescription in hand. Problem is that some develop allergic reactions worse than the viral disease, and occasionally a severe reaction known as Stevens-Johnson disease, which is very difficult to treat, and may lead to permanent complications.) If the conjunctivitis doesn't resolve, or if there are certain characteristics to it that a skilled ophthalmologist recognises, Chlamydial disease may be suspected. Since even the ocular form is actually systmeic, oral tetracycline must be given for 2-3 weeks, and the person's sexual partner must be treated at the same time even if asymptomatic, to prevent recurrence after treament is over. All in all, Chlamydial disease is not cut-and-dried. Fortunately, researchers are developing immunologic tests to diagnose this from smears or exudate quicly, without sophisticated culture techniques. -- ==================================================================== David Robins, M.D. Smith-Kettlewell Institute of Visual Sciences 2232 Webster St; San Francisco CA 94115 415/561-1705 {ihnp4,qantel,dual}!ptsfa!ski!dr The opinions expressed herein do not reflect the opinion of the Institute!