Letters: November 2010


Pharmacists speak out about choosing the right antibiotic, prescription drug abuse, and generic acquisition costs.

Key Points

Bum call on that carbuncle

Too many prescribers see a "bad" infection and think they need a "strong" antibiotic, and their knee-jerk reaction is to throw Levaquin at it instead of something that is appropriate. Now MRSA is showing signs of resistance to the drug, thanks to overprescribing. That's how Cipro lost its gram-positive spectrum.

Bactrim is job 1

Mr. Plagakis criticized a physician's prescription to treat what appeared to be a huge abscess on a patient's shoulder. Nowadays such abscesses are caused by community-acquired MRSA. First-line treatment for such infections is Bactrim, after they are incised and drained, if they are advanced enough for such incision. Mr. Plagakis criticized the choice of Bactrim and told the doctor that Bactrim was not used for Staph. When the doctor suggested vancomycin, he was told that it was "too toxic for the first round."

The problem with Vanc is that it is not absorbed from the GI tract; it must be given intravenously to a patient with a MRSA infection, usually in an inpatient setting. Mr. Plagakis suggested the use of Levaquin. However, Levaquin is not active against MRSA. Bactrim is first-line, followed by clindamycin and/or doxycycline, with linezolid for suspected MRSA. You need to check current literature before criticizing the correct choice of a drug made by a physician.

Cezary Wojcik, MD, PhD

(Editor's note: Through editorial error, the column was not fact-checked before publication. Drug Topics regrets the omission and thanks the readers who sent e-mails of correction.)

Preaching to the choir

Re: Mr. Randeria's editorial about prescription drug abuse ["Controlled substance dilemma," September 2010], I say "Amen!"

In addition to the factors Mr. Randeria listed, I suggest that the JCAHO Standard for Pain Management adopted in 2001 has contributed significantly to the problem. Pain is a subjective sensation that cannot be measured by any laboratory test or X-ray. Doctors have only the patient's report to base their decision on, and for nearly 10 years they have been instructed to treat pain as the fifth vital sign. It is easier to write the prescription than to address the possibility of drug addiction or diversion. We need more professional cooperation and coordination to tackle this thorny problem.

Sno White-Benson, PharmD

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