surgeons nose

Hans Erik Busk busk at
Thu Aug 10 12:45:28 EST 1995

>gather cumulative data. I must say I am not happy about this more limited 
>role of the labs, but you play the hand you are dealt with...

Well, maybe you  can grab a stack of cards yourself and deal some

>Agreed, however, discerning which are doctor tranquillizers and which are 
>genuine rush cases is difficult from the lab or pharmacies more removed 

In Denmark the clinical microbiologist is a doctor who have treated
patients for 5 to 6 years, before even beginning to specialize in
microbiology. Usually he plays a very active role in the diagnosis and
treatment. He even uses a stethoscope!! 
He surely does not want tho play hazard with the patients lives.

>Regardless of what misuse caused it, at some point every front line drug 
>reaches a point where it is not hitting a high enough percent of 
>pathogens to be a front line drug. My contention is that at our 
>institution, oxacillin and the cefs have reached that point because of 
>MRSA saturation. What then should be the break point? When do you switch 
>to a new front line drug, and what do you do with your epidemiology and 
>pharmacy controls oriented around the old frontline?

I really don't like the term "Front line drug". It implies that the
doctor does not have to think. He just have to use the current "put
your head under the arm drug". It is very seldom that you doesn't have
a clue that can guide you in selecting the appropriate drug, which
migt be no drug.

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

As I wrote - we once had a world record in MRSA in Denmark. Within
five years the incidence had dropped to a few percent, and it has been
belov 1% for the last 15 years. We restricted use of  antibiotics in
general and specially the  broad spectrum drugs (tetracycline was
probably one of the worst drugs at that time),  made a lot of
improvements in hospital hygiene, and decentralised the clinical
microbiological departments so that now we have a department in every
county (average population 300.000).

I think we have demonstrated that you can regain the lost territory.
But you surely have to forget the typical american (sorry I couldn't
resist it :-) answer to problems: throw some more $ and technology in.

Hans Erik Busk
busk at

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