Nobody has been blaming Bush for this so far ?!! :D

Australia had a real problem with this several years ago because of over perscribing of AB's.

I worked for a guy who took AB's everytime he got a cold and we were praying that he would never have a real issue as his body was so used to AB's that the standard treatment would not have done any good.

I take them only when there is no other choice and have consumed them less than 4 times in 10 years.

Problem is that those of us who travel for a living are exposed to all sorts of crap as well as too many people want a magic pill that cures everything.

I notice Kevin didn't have health insurance....

What does someone do who is faced with major invasive surgery in the near future?

Only health insurance I have is what I pay for out of my pocket every month. There are a lot of us in this situation.

As well I know a lot of people who are trapped in their job because they cannot leave and lose their health insurance. As you get older it gets worse...

Along those lines ---

Does alcohol based hand sanitizers help to kill the MRSA related bateria before it gets into the body? Would cleaning wounds, cuts and abrasions with an alcohol swab help? (A nurse type person told Mrs. Z-man that rubbing alcohol doesn't kill the bateria - but I serious doubt those claims...)

As a diabetic, I prick my finger 4-5 times a day for blood tests and take insulin injections. So I have tiny little holes in my fingers due to the blood tests. Would I see signs of infection around these holes if I were infected with MRSA, if the bateria entered my body via these holes?

-Z-man.

Uh oh...

If alcohol doesn't work, I would think that hydrogen peroxide would.

Waiting for the medical professionals to confirm/deny.

I wish doctors would speak more statistically to me. What I mean is, I show up with 'infection'. Doc says "I COULD prescribe AB, but I feel 95% sure this is viral, and it wouldn't have an effect." That would be easier to take than "Drink fluids and pay the nurse $50 on your way out."

I actually have seen both listed in texts, I think you are right though, poor proofreading. Will have to write that guy a letter as I actually looked that up. Thought it was wrong when I typed it.

#1 Wash your hands more frequently
#2 If you get a cut or scratch, treat it no matter how minor it seems
plan to file bankruptcy after

Rammstein, you will never get someone to tell something like that precisely. How you going to defend that in court? Z-man, the alcohol does not sterilize the skin, it reduces the bacterial load. Can't sterilize your skin unless you take it off and cook it.

If you have yellowish pus, you probably have staph of some sort. If you are diabetic, you have several infecting bacteria, which complicates things. Your immune system is not the same as someone elses is, sorry. If it is infected, it usually is a bit red around it, but in a diabetic this is not always the case due to immune compromise and poor inflammatory response. The alcohol based handcleaners are like soap, contact time is important.

The antibiotic effectiveness against MRSA is pretty interesting. Some stuff works in a dish, but not in a person. Linezolid is a great drug, bone penetration is similar with IV or oral form, only one that is true of that I know. This will get overutilized and resistance will rise, just like what happened with Cipro.

You never see Rifampin alone because of rapid development of resistance, or that is what an ID guy told me once.

As far as I know, alcohol does pretty well in killing all sorts of bacteria, MRSA included. There are many alcohol-based surgical hand scrubs and patient preparation solutions. However, the problems with alcohol: it dries the skin (particularly if you're using it repetitively--this part's fact), and there's not much money to be made in it (so soap/pharmaceutical companies aren't that enthusiastic about making a bazillion products with it--this part's my opinion). But alcohol's a pretty good cleansing agent.

edit: Like Tobra points out, it's impossible to completely sterilize your skin--but with proper hygeine and technique, you'll reduce the bacterial load to as low as possible, and let the body's immune system take care of the rest.

For people like Z-man, who have to do multiple fingersticks on a daily basis and worry about that as a portal of entry (as well as the diminished immunological status from the underlying diabetes), that's a good reason for using good sterile technique when you're doing said fingersticks, and good hygeine in general to keep your hands clean.

MRSA is probably all over the place, by now. I wouldn't be surprised if it was colonized on your, and my, and everyone else's skin. But there's a difference between colonization (where the bacteria grows/sits benignly) and infection (where the bacteria is causing a problem). You still have your natural immune system to fight off MRSA, as well as all your body's other barriers to infection (such as your skin, the lining of your gut, etc.). So just because you're colonized with MRSA doesn't mean you're necessarily infected with it, or going to be infected with it.

Rammstein brings up a good point. If a patient may potentially have an infectious problem, we live in a society where it's far easier to overprescribe antibiotics and at least look like we're trying to do everything we can to take care of a potentially infectious problem. You (as a patient or family member or parent) most likely would be a lot less pissed if a doc apparently tried all that was available and needlessly overtreated a condition, than if you felt that you were blown off by the doc and NOT given an antibiotic when that's possibly what might have solved the problem. Don't know if that last sentence makes sense. But we seem to live in a society where it's more acceptable to overtreat a condition, than it is to potentially undertreat it (even if the odds are in that 5% category) and possibly result in a complication that could have been prevented had we gone in with guns ablazin' from the get-go. We forget (both docs and patients) that there is actually a big-picture negative to overtreating.

Tobra, Noah -- thanks for the responses. Fortunately, I don't have any yellowish puss or redness anywhere on my body that I can see. And it is reassuring to know that I can take precautionary measures to minimized the chance of infection. I believe that those measures (washing hands, using alcohol pads...etc) are far more effective than using antibiotics - since at this point the bateria hasn't been able to mutate enough to be resistent to such measures.

-Z-man.

This begs a question:

Why do Doctors prescribe an antibiotic to a patient simply because the patient wants it? Who is in charge here, the expert or the patient? Seems as if this "defensive medicine" idea is going too far.

I ask for no medications that are not recommended by the physician, and I question every time one is recommended. Your well being is your responsibility, and the physician is only there to recommend and to assist in your quest to stay healthy.

1. Patient is in charge. Always. I'm just here to advise, and intervene if requested.

2. Patients frequently think they're experts. I get that attitude on a daily basis.

3. We live in a society where it's OK to overtreat, as it looks like you've done everything possible (even doing stuff that wasn't really necessary). But it's not so OK to undertreat, as it looks like you don't know what you're doing. If you overtreat (erroneously provide care where it wasn't truly necessary), there are negatives--but they're long-term items that don't directly impact the patient in the immediate future. If you undertreat (erroneously not provide care where it was indicated), there are also negatives--but the price that has to be paid is much more immediate and personal to the patient. So it's socially easier to "err of the side of caution" and overtreat. You're a lot less likely to get sued for overtreating than the other way around.

A couple of questions:

1. My teenage son has severe acne. This clearly opens his skin to other bacteria in an environment that is rich with opportunities for infection (high school). Does his risk increase by orders of magnitude?

2. I make frequent trips to Afghanistan. I am told to take Doxycycline as a prophylactic against Malaria. Does this frequent use of this drug increase the opportunity for resistant bacteria to thrive? BTW, the area that I spend most of the time in Afghanistan has very high fecal content dust.
Thanks,
Jim S.

Thanks, Tobra. I wasn't referring to a lack of health insurance though. I was more concerned about MRSA.

With regards to alcohol, yes it will kill MRSA. The problem is that straight rubbing alcohol is very drying to the skin and so not really suitable for daily use. The old alcohol rubs were also pretty drying, but they are now coming out with alcohol based cleansers that also have moisturizers in them and don't dry the skin as much. That's what I use at the hospital I work at and my skin doesn't dry out. The bottles are on the walls by the door to the room, get a squirt in the hands on the way in and a squirt on the way out...little dab 'l do ya!

The only bug (that I know of) that won't be effectively neutralized by an alcohol based lotion is Clostridium Difficile, that bug has a spore form which is only effectively removed by good old fashioned soap and water.

MRSA is in the community, it's just a fact at this point. It is not, however, this menace that is waiting to kill you at a moment's notice. It's another bacteria just like other bacteria. It's just more resistant to antibiotics. That doesn't mean that with good hygeine you can't live a full and MRSA free life.

MRSA is the big thing now, but don't think this is the only bug that we will see develop multi-drug resistance. It's up to the pharmaceutical companies to keep pumping out new types of antibiotics that are effective against these resistant bacteria. Of course the other option would be to stop using antibiotics altogether and wait about 100 years. Then they would all probly work again...

Just change your name from Joe to Jose and tell them that you're "not from around here" , then you can get health care for free ;)

High fecal content dust? I think that means the air is full of *****.
Why in the world would anyone voluntarily go to place like that?
I don't even like going to Los Angeles.

It's crappy job, but somebody's gotta do it.