A patient just came into my work with a prescription for a Z-pack...

[Gravitycollapse]

Reason?

"Cough"

This is why we have drug resistant bacterial infections. I suspect the large private urgent care this patient came from likes to do this a lot.

[CaliforniaPeggy]

1. This could be contributing to the drug resistant antibiotics...

What I've read says that giving antibiotics to animals is where it really happens. That is a very large scale operation, much larger than humans getting those drugs for coughs or viruses.

[Pretzel_Warrior]

3. Good point. Thus far, all that will happen on that matter is for veterinarians to dissuade farmers

from using antibiotics other than for actual sickness in their animals.

[Doremus]

22. Antibiotics are a daily staple for livestock in factory farming.

I remember several years ago, as one after another of our antibiotic arsenal was rendered useless against resistant bacteria, scientists asked the livestock industry to kindly halt the overuse of lifesaving people meds. They might as well have saved their breath.

Dead humans vs. a few pennies less profit? No contest.

[DesertFlower]

4. it's both. i remember years ago i had

a cough -- not a cold -- just an annoying cough. i went to the medical department at work (mobil corp - 1977) to get some cough syrup. the doc wanted to give me an antibiotic. i refused and at lunch time i went to the store and bought some cough syrup -- problem solved.

[etherealtruth]

2. No doubt

My ex-husband (generally intelligent and reasonable) flips out if I don't 'get the kids put on antibiotics" for diagnosed viral infections.

[hatrack]

17. For viral infections? Sheesh . . .

nt

[Warpy]

5. It's less likely to happen with a z-pack

because they are designed to be taken only for 5 days instead of two to three weeks, long after the person feels better. The medication in the z pack has a long half life and will stay in the person's system for a couple of weeks after the medication has been finished.

That's why the bugs are fighting back, too many people feel better, don't finish the medication and try to save it for the next time they get sick. That's as much a reflection of our piss poor healthcare system as it is anything else.

[Scootaloo]

6. We'd get drug-resistant bacteria anyway; that sort of thing just speeds it up

We're just not on the winning side of that particular biological arms race.

[curlyred]

7. Only thing that helped my cough

The Z-pack is highly effective against pertussis. Better to take this while waiting than risk infecting defenseless babies.

I didn't know I had whooping cough, but my doctor did. Prescribed the Z-Pak in the meantime. She was right, and I was prevented for infecting further unfortunates,

[seattledo]

8. This is why we need more government control of healthcare

The AMA has done a very poor job of policing their own.

[Marrah_G]

14. There may well have been a very good reason the doctor prescribed it

I prefer to leave those decisions to the doctors and not Washington.

[Manifestor_of_Light]

9. Snot/lung gunk color tutorial:

If it's white or clear, you have either allergies or a virus. Antibiotics don't work against viruses (virii?).

if it's yellow or green, you have a BACTERIAL INFECTION. Antibiotics KILL bacteria. Please do not ask your doctor to give you antibiotics if you have a "cold" or "virus". Won't work.


I have a biology degree, so I know just enough to be dangerous. You're welcome.

[MH1]

23. Interestingly, I've had yellow/green snot/lung gunk many times

where I didn't go to a doctor, didn't take antibiotics, and it cleared up just fine on its own.

Just because it's bacterial doesn't mean antibiotics are required. Obviously for someone with a compromised immune system, a trip to the doc might be a good idea; but for young healthy folks, usually your body can handle it.

[leftyohiolib]

10. could also be that this person is ill and may not feel like going into a more lengthy

reason other than the shortest quickest easiest response of cough.

[Drahthaardogs]

11. No. Statistically even if "overprescribed" taking a full course of antibiotics poses little risk.

Most drug resistance can be blamed on the practice of feeding low-level antibiotics to bees, chickens, swine, and hogs in an agricultural setting and/or the improper (read incomplete courses) use of antibiotics in countries where they are not regulated.


http://www.nature.com/news/pig-manure-fertilizer-linked-to-human-mrsa-infections-1.13752


It is the new MD bandwagon, but sadly most believe it. Just as most MD's believe that moist snuff is as (or more some say) carcinogenic than cigarettes, when the relative risk of oral cancer from snuff use alone is near zero statistically speaking. I absolutely HATE it when physicians accept the talking point of the day without really researching it.

[ConcernedCanuk]

12. I haven't had much luck with antibiotics.

.
.
.

I had one infection 15 years ago that progressed despite oral, topical and intravenous antibiotic treatment over 5 months.

It was a skin infection that was open sores that started out at my ankles and moved upwards, jumping to my forearms.

This started in March, long before outside trips without sox or shoes so it was not from the bush.

It would appear much like a fly bite, and very itchy - then get larger, red, open and oozing puss.

I was already aware of probiotics, and also aware of airborne toxins that can be absorbed by skin hair and stored.

One day while shaving, the itching on my one leg got so bad I shaved it, through puss and all.

The pain from the shaving was a welcome relief to the overwhelming itching.

Stopped all antibiotics, bumped up my probiotics - within 4 days - an improvement, itching subsiding, sores stopped progressing.

Shaved the other leg and all other affected areas.

7 days almost no more itching, sores started to heal

3 weeks all symptoms gone, except

I had nicely shaved legs and arms!



CC

[Marrah_G]

13. It could be bacterial

Now granted, the doctor might have just written the script to shut the person up, but there also might have been a good reason.

I think the doctor is best qualified to say.

[gollygee]

15. +1

"Cough" might be "bacterial infection which causes cough"

[MineralMan]

20. Indeed it might. Or it could be gonorrhea that was the reason

for the prescription. For a pharmacy worker or even a pharmacist to ask why a medication was prescribed is a serious violation of HIPAA rules. It is none of their business, and that is why a diagnosis is not part of a prescription.

There are reasons that such questions are not appropriate, and they are many. It is simply none of the pharmacy's business why a physician prescribed a medication. Such questions are prohibited under HIPAA. If a pharmacist questions a prescription, that question should be asked of the prescribing physician, not of the patient presenting the prescription.

Such improper questions should be reported to the actual pharmacist at the pharmacy or to the owner of the pharmacy. They are simply improper.

[William769]

24. You hit the nail right on the head.

But then again I'm considering the source (OP).

[MineralMan]

16. Perhaps the physician learned more from the patient than "Cough."

After all, the physician examined the patient, while the pharmacy worker did not. Wanna be a doctor? Go to med school. Making a diagnosis based on a patient's one word isn't actually recommended. In fact, questions about why I was prescribed a medication should not even be asked by the pharmacist or any employee of the pharmacy. It's none of their business. If I am asked such a question, I will respond with a WTF look and a pointed question regarding their HIPAA compliance.

I hope that patient's prescription was filled and handed to him or her without any negative comments. I had a pharmacy worker tell me once that I didn't need the medication my physician had prescribed. I asked for the pharmacist to come to the counter, and asked whether or not the worker who gave me that advice was a physician. She agreed with me that the advice was uncalled-for.

I expect my pharmacist to spot issues with drug interactions. I expect my pharmacist to tell me about possible side effects and to advise me on how to take the medication. I do not expect, nor will I accept, advice from people working at the pharmacy about the diagnosis or treatment prescribed by my physician.

The pharmacist is neither qualified nor takes the time to examine me. That's the physician's job.

[pipi_k]

18. Lots of...

good points above.

The person might also have a bacterial infection.

Livestock being fed antibiotics is a real concern.

And longer dosing times (10 to 14 days with other antibiotics) often means people will stop taking them when they feel better, meaning the bacteria which weren't killed off in the first few days may develop immunity. That's what's good about the Z-pack. Only a couple of days on it.

That having been said, I'm on a regime of my own. Raw garlic (crushed) each day to prevent the same head cold that Mr Pipi has had since Christmas Eve. So far I'm just a bit sniffly, which could be my year round rhinitis. I don't feel sick, so maybe it's working. Raw garlic, so they say, is antibacterial, antiviral, and antifungal.

I've been doing it each winter for the past six years or so, and only got one head cold in all that time, and even that was less severe than usual and was shortened by about 2 days.

And no bronchitis, either...the last case of that was in 2005.

So. As long as it keeps working, I'll keep doing it.

[MineralMan]

19. Futher, here is the patient flyer documentation on reasons for prescribing

a Z-pak:

Zithromax Z-Pak oral is used to treat the following:
Strep Throat, Strep Throat and Tonsillitis, Acute Gonorrhea of the Urethra, Acute Gonorrhea of the Cervix, Highly Infectious Venereal or Sexually Transmitted Ulcer, Infection of the Urethra caused by Chlamydia Trachomatis, Bacterial Infection of Cervix due to Chlamydia Trachomatis, Infection of the Middle Ear by H. Influenzae Bacteria, Middle Ear Infection caused by Moraxella Catarrhalis, Infection of the Middle Ear by S. Pneumoniae Bacteria, Middle Ear Infection, Severe Sinusitis caused by Streptococcus Pneumoniae, Severe Sinusitis caused by Haemophilus Influenzae, Severe Sinusitis caused by Moraxella Catarrhalis, Pneumonia caused by Pneumococcus Bacteria, Bacterial Pneumonia caused by Haemophilus Influenzae, Pneumonia caused by Mycoplasma Pneumoniae, Pneumonia caused by the Bacteria Chlamydia, Bacterial Infection with Chronic Bronchitis, Severe Episode of Chronic Bronchitis due to H. Flu, Severe Episode of Chronic Bronchitis by M. Catarrhalis, Severe Episode of Chronic Bronchitis due to Streptococcus Pneumoniae, Chlamydia Trachomatis Infection of Female Pelvic Organs, PID with Gonorrhea, Mycoplasma Hominis Infection of the Female Pelvic Organs, Skin Infection due to Staphylococcus Aureus Bacteria, Skin Infection due to Streptococcus Pyogenes Bacteria, Skin Infection due to Streptococcus Agalactiae Bacteria

Inquiries from pharmacy employees regarding the reasons this medication is prescribed by a physician are a violation of HIPAA. As you will note in the list of reasons to prescribe, STDs are some of the most common reasons, and are near the top in the list. If a pharmacy worker inquires about the reason for a prescription, they are asking for information they are not entitled to have, and for obvious reasons.

There is no information regarding diagnosis on a prescription other than a code number. No pharmacist or pharmacy worker should ever question a customer regarding the diagnosis the medication is prescribed to treat.

It is none of the pharmacy's business. If I were asked by a pharmacy employee why I was prescribed a medication, I would refer them to HIPAA. If the person was not the pharmacist, I would insist on speaking to the pharmacist and make it clear that such questions are a violation. Then, I would report the violation.

Pharmacy workers have no business asking patients with prescriptions anything about their diagnosis. Ever. It is not their job, and HIPAA prohibits such questions.

[MineralMan]

21. How do you know the reason for the prescription?

Did you ask the patient? If so, you were in violation of HIPAA rules. I wouldn't admit to that publicly, to be frank.

Are you a pharmacist? If so, you know the HIPAA rules. If you are not a pharmacist, you have even less reason to inquire about a customer's diagnosis. That is not appropriate in any way. Had you asked me that question, you'd have gotten a sharp response and a reminder of HIPAA rules. If I were not satisfied that you would not do that again, I would report the pharmacy and take my business elsewhere.

Pharmacies cannot ask patients why a medication was prescribed. If they question the prescription, they should communicate with the prescribing physician. Pharmacists are not physicians.