surgeons nose

Robert Morrell Jr. bmorrell at ISNET.IS.WFU.EDU
Wed Aug 9 07:21:16 EST 1995


On Wed, 9 Aug 1995, Hans Erik Busk wrote:

> Of course you can never be absolutely sure of anything in the
> universe, but if the clinicians don't use the result from the lab, then
> what is the purpose of taking the specimens?
>=20
I have often wondered about that very question. Apparently to gather=20
information in the event the empiric therapy does not get the bug, and to=
=20
gather cumulative data. I must say I am not happy about this more limited=
=20
role of the labs, but you play the hand you are dealt with...

>=20
> Sometimes we see antibiotics used as "the doctors tranquillizer"
>=20
Agreed, however, discerning which are doctor tranquillizers and which are=
=20
genuine rush cases is difficult from the lab or pharmacies more removed=20
perspective. It would be a game of chicken played with patients.

Remember that we are talking about waiting 24 to 48 hours for culture=20
data! That is a very long time in an infectious process, particularly if=20
the patient has already progressed before for the cultures were taken.

But my core question remains:

Regardless of what misuse caused it, at some point every front line drug=20
reaches a point where it is not hitting a high enough percent of=20
pathogens to be a front line drug. My contention is that at our=20
institution, oxacillin and the cefs have reached that point because of=20
MRSA saturation. What then should be the break point? When do you switch=20
to a new front line drug, and what do you do with your epidemiology and=20
pharmacy controls oriented around the old frontline?
> I am afraid that I don=B4t understand this shortsightedness, or myabe I
> am just wrong ;-)

I agree that it is short sitedness, and foolish. My question however is=20
not one of what should have been done, but what to do now, with the added=
=20
remove of the lab or pharmacy perspective, where we can talk and educate=20
but in the end, it is the physician who makes the call.

It seems to me that any ab control program that starts by backing a lost=20
cause is doomed to failure.


*                     Bob Morrell                       *
*              bmorrell at isnet.is.wfu.edu                *
* The operation was a success, as the autopsy will show *




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