still more antibiotic over-prescription?  absolutely!

NOT SURE ABOUT THE DIAGNOSIS?
HIT ‘EM WITH ANOTHER ROUND OF ANTIBIOTICS!

“Antibiotic therapies are used for approximately 56% of inpatients in U.S. hospitals, but are found to be inappropriate in nearly half of these cases, and many of these failures are connected with inaccurate diagnoses”  Dr. Greg Filice, from last week’s news release by the Society for Healthcare Epidemiology of America.  Dr. Filice was the lead author of the study below and is a Professor of Medicine at the University of Minnesota’s School of Public Health, as well as being Chief of the VA Infectious Disease Section.  The following quote is from the study itself. Negative consequences of inappropriate antimicrobial use include clinical failure, adverse drug events, and excessive costs. Regardless of appropriateness, all antimicrobial use establishes selective pressure that contributes to the relentless emergence of resistance in a broad array of pathogens.”

How many times have we talked about the OVER-PRESCRIBING OF ANTIBIOTICS and the rise of “THE SUPERBUGS“?   I know, I know, I know; a lot.  But it’s a drum I need to keep beating because not only is this problem not improving like it should be, ultimately it affects us all in ugly ways (HERE).  Case in point, the study that was published in this month’s issue of Infection Control & Hospital Epidemiology (Diagnostic Errors that Lead to Inappropriate Antimicrobial Use).

In this study, 500 random individuals that had been selected at random from a larger random pool had their records pulled for review.  Four board-certified internists with specialties in infectious disease looked at said records to determine accuracy of the diagnosis, as well as the “appropriateness” of the Antibiotics that were prescribed.  “Based on data available to providers at the time, infectious disease literature, guidelines, textbooks, and reviewer professional judgment, reviewers independently classified these provider diagnoses as correct, indeterminate, incorrect, or a sign or consistent with an infectious disease.  Cases were classified as indeterminate when the evidence supporting the diagnosis was unclear or lacking.  In contrast, diagnoses were classified as incorrect when the evidence disproved the diagnosis or clearly supported an alternative diagnosis.   Here is what they found.

  • INDETERMINATE:  22% of the time the diagnosis was too vague to determine much of anything about the case.  For example, a diagnosis of “FEVER” doesn’t provide much meaningful information about what’s wrong with someone.

  • INCORRECT:  For some of the most common diagnostic categories, the agreement between physician and reviewer was just over one in four (27%).   For instance, in 76 cases of cystitis that were reviewed, the reviewers agreed with the treating physicians only 13% of the time (10 cases).

  • INAPPROPRIATE:  Even when the diagnosis was correct, almost 40% of the Antibiotics prescribed were, by definition, inappropriate.  That number went to 95% (ninety five percent) when the diagnosis was incorrect, which, as you’ve already seen, was a great deal of the time.   “In 166 of 198 cases (84%) with diagnoses that were incorrect or indeterminate or when providers were treating a sign or symptom rather than a syndrome or disease, antimicrobial therapy was not indicated at all.

Treating symptoms instead of dealing with underlying causes of said symptoms.  For the most part, this is what our modern medical system is all about.  The problem is, it leads to the sorts of zany conclusions like the ones found in this study.  For instance, the authors stated that, “Diagnostic errors were more common in this study than in previous studies unrelated to antimicrobial use.”  I cannot tell you why this was with any degree of certainty, but I can tell you that when it comes to drug reactions; they are almost UNIVERSALLY UNDER-REPORTED —- severely under-reported.

And when it comes to amazing statements, this one takes the cake.  “Antimicrobial use is heavily shaped by cultural and economic factors related to deeply held beliefs about bodily integrity and invasion.”  This is why I truly believe that many of you will never get healthy or LOSE THE WEIGHT you need to without understanding the HYGIENE HYPOTHESIS.  Viewing germs as “invaders” produces “CLEAN FREAKS” and bacteriophobes.   “Antimicrobials have been labeled drugs of fear in that fear of bad outcomes, however unlikely, leads to antimicrobial overuse despite associated risks, including adverse effects in individual patients and relentless increases in antimicrobial resistance generally.”  We know that not only are Antibiotics killing off our collective MICROBIOMES and causing an array of problems associated with DYSBIOSIS (too many “bad” bacteria, and not enough “good”), but are actually causing certain strains of bacteria to BECOME EXTINCT as well.   Once you have an understanding of GUT HEALTH, all of this will begin to make sense.

The same journal published a study (Unnecessary Antibiotic Use in Hospitals Responsible for $163 Million in Potentially Avoidable Healthcare Costs) back in September of 2014 dealing with — as you might guess from the title — the excess costs related to this problem.  The press release for the study stated that, “The Centers for Disease Control and Prevention (CDC) and Premier, Inc. have released new research on the widespread use of unnecessary and duplicative antibiotics in U.S. hospitals, which could have led to an estimated $163 million in excess costs. The inappropriate use of antibiotics can increase risk to patient safety, reduce the efficacy of these drugs and drive up avoidable healthcare costs.  These costs do not include other operational factors, such as the associated supply and labor costs, or patient safety complications. In addition to antimicrobial resistance and excess costs, unnecessary intravenous combinations can increase the risk of adverse drug events. Each drug has a risk of side effects, and combinations increase those risks as well as the risks for drug-drug interactions.

Not only is the 163 million dollars figure ridiculously low, none of this takes into account the real cost of Antibiotic overuse.  The destruction of our nation’s health.  Chronically sick children (HERE is one example of many).  Rampant INFLAMMATION and widespread AUTOIMMUNITY.  I would even argue that it can be part of the process that leads to things like FIBROMYALGIA or CENTRAL SENSITIZATION.   Make sure to take DR. MENDELSOHN’S ADVICE and do whatever it takes to keep your family and yourself off of Antibiotics!

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