Antibiotics.

Xenophile

First and foremost let me say that I am not looking for advice as I know that it is not allowed on this forum.

Just to relate that I was in Spain recently and I got an inflammation of the gums, nothing too serious just affected one area of my mouth.

As I knew that antibiotics are freely dispensed over the counter without any need for a prescription I went along and got them there. I asked the young pharmacist if there was any need to finish out the course as I had always being brought up to the idea that antibiotics had to be taken as a full course.

The young pharmacist said not at all, just take one every eight hours until you feel better and as it happened I felt much better after taking just two and I was wondering if I should even bother taking a third, I took the third must admit that I told the pharmacist that I also intended to take a few whiskeys which I did. On the following day the inflammation on my gum was completely gone. But I was so wiped out that I could hardly get out of bed, now let it be said that I did not overdo the whiskeys, just three in all.

The antibiotic in question was "amoxicillin 500 mg/125mg" huge big lump of penicillin in a carton of 30 which I believe if all were to be taken they were strong enough to kill a horse.

Just wondering are there different opinions on finishing out what's supplied in a carton?

May I emphasise again that I am not looking for advice but would be interested to hear views on the subject.

locum-motion

First of all, "amoxicillin 500 mg/125mg" is nonsense; it means nothing. I mean, the first part of it does, but the "/125mg" bit means nothing on its own.

What it probably should say is "Amoxicillin/Clavulanic Acid 500mg/125mg".

125mg of Clavulanic Acid, added to a dose of Amoxicillin (either 250mg or 500mg), will prevent an enzyme called Beta-Lactamase from breaking down the Amoxicillin. Some bacteria have the ability to manufacture Beta-Lactamase, which means they are Penicillin-resistant. However, by inhibiting the Beta-Lactamase, the Clavulanic Acid prevents otherwise-Penicillin-resistant bacteria being Penicillin resistant.

Secondly, unless your horse is allergic to penicillin, the course of antibiotics wouldn't have killed it.

Thirdly, the pharmacist in Spain was talking through their hole, and also was breaking the law. Prescription laws in Spain used to be much laxer than they are now, but perhaps some pharmacies still flaunt the laws, particularly if they reckon that the English-speaker in front of them is unlikely to be an inspector from their equivalent of the PSI.

You should always finish the course of an antibiotic, because the length of the course is what has been found by research to be the optimum time required to kill the infection completely for most patients. If the infection isn't killed off completely, some of the causative bacteria are left behind, and these bacteria have been exposed to a sub-lethal dose/period of treatment of the antibiotic. These can then flourish into a new infection. There is a greater chance that these new bacteria, descended from the survivors, will have a resistance to the antibiotic next time.

RobFowl

Suppose this demonstrates just why otc antibiotics with little control is a really bad idea.
I'm no dentist but am fairly sure co-amoxiclav is not he best treatment for gum inflammation by any means.

Xenophile

locum-motion wrote: »

First of all, "amoxicillin 500 mg/125mg" is nonsense; it means nothing. I mean, the first part of it does, but the "/125mg" bit means nothing on its own.

What it probably should say is "Amoxicillin/Clavulanic Acid 500mg/125mg".

125mg of Clavulanic Acid, added to a dose of Amoxicillin (either 250mg or 500mg), will prevent an enzyme called Beta-Lactamase from breaking down the Amoxicillin. Some bacteria have the ability to manufacture Beta-Lactamase, which means they are Penicillin-resistant. However, by inhibiting the Beta-Lactamase, the Clavulanic Acid prevents otherwise-Penicillin-resistant bacteria being Penicillin resistant.

Secondly, unless your horse is allergic to penicillin, the course of antibiotics wouldn't have killed it.

Thirdly, the pharmacist in Spain was talking through their hole, and also was breaking the law. Prescription laws in Spain used to be much laxer than they are now, but perhaps some pharmacies still flaunt the laws, particularly if they reckon that the English-speaker in front of them is unlikely to be an inspector from their equivalent of the PSI.

You should always finish the course of an antibiotic, because the length of the course is what has been found by research to be the optimum time required to kill the infection completely for most patients. If the infection isn't killed off completely, some of the causative bacteria are left behind, and these bacteria have been exposed to a sub-lethal dose/period of treatment of the antibiotic. These can then flourish into a new infection. There is a greater chance that these new bacteria, descended from the survivors, will have a resistance to the antibiotic next time.

Firstly let me thank you for going to the trouble of replying to my post in such a comprehensive way. As regards the name ............the name in Spanish on the outer container is "Amoxicilina/Acido clavulanico Sandoz 500mg/125mg. I googled to get the best translation I could. I appreciate you expressing your views on the subject. By the way the way the pharmacy is on one of the Canary Islands where they are well used to flaunting the law. I am sure there will be more strict oversight here, but I hope it never gets to the stage that exists in Ireland where you cannot get a 100mg Aspirin without a doctors prescription.

locum-motion

Xenophile wrote: »

... but I hope it never gets to the stage that exists in Ireland where you cannot get a 100mg Aspirin without a doctors prescription.

There is no need for anyone to get 100mg of aspirin... ever.

But if there was, you would need a prescription for it.

Aspirin 75mg is prescription only.

300mg, 325mg, 500mg etc are available without a prescription.

Xenophile

locum-motion wrote: »

There is no need for anyone to get 100mg of aspirin... ever.

But if there was, you would need a prescription for it.

Aspirin 75mg is prescription only.

300mg, 325mg, 500mg etc are available without a prescription.

Thanks for the above information in Canary Islands it seems that Aspirin is only available in 100 and 500mg. Brand name "Adiro" a Bayer product.

I wonder what the reasoning is for 75mg to be prescription only.

Kurtosis

Xenophile wrote: »

I wonder what the reasoning is for 75mg to be prescription only.

It's licensed to be used as preventative treatment in people with heart conditions. Such people should be managed by a doctor and so seeing them regularly, hence getting a prescription for aspirin is not an issue. Low dose aspirin is not licensed for other people.

L1011

locum-motion wrote: »

Thirdly, the pharmacist in Spain was talking through their hole

I've noticed comments elduing to this conclusion elsewhere too - people reporting Spanish pharmacists giving them entirely different drugs (generally varying between different PPIs or statins) that don't match their prescription because they're cheaper or because the pharmacist prefers them.

locum-motion

MYOB wrote: »

I've noticed comments elduing to this conclusion elsewhere too - people reporting Spanish pharmacists giving them entirely different drugs (generally varying between different PPIs or statins) that don't match their prescription because they're cheaper or because the pharmacist prefers them.

My comment about the Spanish pharmacist talking through their hole was entirely referring to what the OP said they said about Antibiotics, and was nothing whatsoever to do with PPIs or Statins.

L1011

What I was referring to was legally and/or medically dangerous actions - as was your post.

hsianloon

usual dose of the drug u mention , commonly marketed as Augmentin in Ireland, is usually a dose of three times a day for 5-7 days depending on the reason for treatment, sometimes extended up to 7-10 days.

You should always finish courses prescribed for simple reasons, resistance.

Think survival of the fittest. If you don't pursue and kill everyone in a group opposed to you by investing your full resources, they will someday recover their strength and offer serious payback, and would have gotten used to your methods of eliminating them.

Mucco

There's been quite a lot of publicity around AntiMicrobial Resistance (AMR) recently:
EU: ECDC
US: CDC
There is a growing number of cases of infection where the current antibiotics just don't work, so avoiding anything that contributes to resistance is paramount.
Having said that, I heard recently from an expert in the field that the evidence for a course of antibiotics being 8 days (or whatever) is quite slim. In many cases, 1 dose might be enough. If anyone knows of literature on this, I'd be really grateful for it.

Nonoperational

This thread is a perfect example of why antibiotics, or indeed low dose aspirin, should be given out without a prescription.

Complete and utter nonsense consultation. I'm not a dentist, but I suspect advising taking a few Co-Amoxyclav for the presenting complaint in this case is not a very prudent course of action. God knows what he'd advise if he tried managing ischaemic heart disease.

Xenophile wrote: »

Firstly let me thank you for going to the trouble of replying to my post in such a comprehensive way. As regards the name ............the name in Spanish on the outer container is "Amoxicilina/Acido clavulanico Sandoz 500mg/125mg. I googled to get the best translation I could. I appreciate you expressing your views on the subject. By the way the way the pharmacy is on one of the Canary Islands where they are well used to flaunting the law. I am sure there will be more strict oversight here, but I hope it never gets to the stage that exists in Ireland where you cannot get a 100mg Aspirin without a doctors prescription.

There's only a select group of people should deb taking low dose aspirin, and they would certainly be under the care of a doctor. It would be a terrible terrible idea if people could go and buy low dose aspirin just because they get some notion about it, as would it be equally terrible if people could go in and get antibiotics without seeing a doctor.

That is nuts that they can do that in Spain. I am constantly taking patients off unneeded antibiotics in hospital. It is a pain in the hole. Although, from what I hear, abx treatment in the UK has improved immensely in the last 15 years.

Breezer

The recent media attention given to the impending co-amoxiclav shortage, and the fact that so many non-medical friends of mine picked up on it and asked me about it in a concerned fashion, really brought it home to me how overprescribed antibiotics are in this country. To me, co-amoxiclav is an antibiotic that should rarely be used in a community setting. It's first line for almost nothing community-acquired, and yet everybody seems to know it, and healthy people worry when they hear it's going out of stock.

What was even more concerning was the letter I got from a pharmacy chain, advising me that they have plenty of co-amoxiclav stocked up, and can continue to provide it "for GPs for whom this is the preferred choice of antibiotic." Who on earth are these GPs and why do they "prefer" co-amoxiclav? Why, instead of taking the opportunity to educate people about antibiotic overuse, is this pharmacy making a business case out of it?

The situation is Spain is ludicrous, or was at any rate. Glad to hear it's being tightened up a bit, if true. Every so often a patient will still bring up Spain when I mention the word 'viral.'

MRSA made headlines continually over the last few years. MRSA is the least of our worries. Why is no one talking about ESBLs? Why is no one telling young people about ceftriaxone-resistant gonorrhoea? It's only a matter of time before we get our first case of total drug resistant TB here. The lax attitude a lot of people still have towards antibiotics scares me big time, and I think doctors and pharmacists really need to start hammering home the message, and in the case of doctors practicing it in their prescribing habits.

echo beach

Breezer wrote: »

Who on earth are these GPs and why do they "prefer" co-amoxiclav?

I don't WHY they 'prefer' co-amoxiclav but I can tell you there are plenty of them about and they always prescribe 500/125 tds, even to the frail elderly who (like many younger, stronger people) can't tolerate such a large dose.
As you found out it is also the 'preferred' antibiotic of the general public, who are disappointed if their doctor prescribes another, in their words, 'weak' or 'useless' antibiotic.

RobFowl

echo beach wrote: »

I don't WHY they 'prefer' co-amoxiclav.

Probably because it tends to work........

Nonoperational

Realistically, in practice, it seems Co-Amoxyclav is pretty much first line for community acquired pneumonia now.

Nonoperational

Nonoperational wrote: »

Realistically, in practice, it seems Co-Amoxyclav is pretty much first line for community acquired pneumonia now.

Only for severe pneumonia (CURB65 3-5). In which case, they should be in hospital anyway. If a person is receiving co-.moxiclav for CAP, it should be IV

Also, carbapenem-resistant Gram-negative species.:(

Nonoperational

Deleted User wrote: »

Only for severe pneumonia (CURB65 3-5). In which case, they should be in hospital anyway. If a person is receiving co-.moxiclav for CAP, it should be IV

Also, carbapenem-resistant Gram-negative species.:(

I know that's the way it should be... but lots of GPs and indeed hospital doctors prescribe co-amoxy for relatively mild CAP.

locum-motion

Virtually every GP and every Hospital doctor in the country prescribes Amoxicillin/Clavulanic Acid for virtually every type of infection.

Vorsprung

locum-motion wrote: »

Virtually every GP and every Hospital doctor in the country prescribes Amoxicillin/Clavulanic Acid for virtually every type of infection.

Do you have a source for this LM?

MrCreosote

It does work, but usually plain amoxycillin will work just as well.

echo beach

In 2011 Amoxicillin with Enzyme inhibitor was the most commonly prescribed antibiotic in the GMS scheme with almost 800,000 prescriptions being written for the 1.7 million people covered. This doesn't include prescriptions for private patients. Amoxicillin on its own was in second place, far behind with just over 460,000 prescriptions.

By any standard that is a lot of prescriptions for co-amoxiclav.

Nonoperational

locum-motion wrote: »

Virtually every GP and every Hospital doctor in the country prescribes Amoxicillin/Clavulanic Acid for virtually every type of infection.

Bit OTT!

I understand the thinking of co-amoxiclav prescribing. Such broad range, will surely knock out the infection but there are serious issues with co-amoxiclav and C.diff that you don't get with amoxicillin and obviously the resistance issie as well.

locum-motion

Vorsprung wrote: »

Do you have a source for this LM?

Just personal experience of the number of Amoxicillin/CA prescriptions that I see, both in my current job and during the preceding 16 years - 7 of them as a locum - when I worked in about 120 different pharmacies.

Haven't done an actual count of it, but it would make very interesting reading if I did. In my current job, I would estimate that I dispense either Amoxicillin/CA or Amoxicillin alone approx twice as often as all other ABs combined, and Amoxicillin/CA is by far the bigger portion of that.

Not working today, though, so can't actually check.

locum-motion

echo beach wrote: »

In 2011 Amoxicillin with Enzyme inhibitor was the most commonly prescribed antibiotic in the GMS scheme with almost 800,000 prescriptions being written for the 1.7 million people covered. This doesn't include prescriptions for private patients. Amoxicillin on its own was in second place, far behind with just over 460,000 prescriptions.

By any standard that is a lot of prescriptions for co-amoxiclav.

Well done, echo beach. You've provided my evidence for me!

locum-motion

Nonoperational wrote: »

Bit OTT!

Well, perhaps slight hyperbole, but not too much!

Breezer

RobFowl wrote: »

Probably because it tends to work........

It does but come on, so would more narrow spectrum antibiotics in most cases.

Xenophile

Xenophile wrote: »

First and foremost let me say that I am not looking for advice as I know that it is not allowed on this forum.

Just to relate that I was in Spain recently and I got an inflammation of the gums, nothing too serious just affected one area of my mouth.

As I knew that antibiotics are freely dispensed over the counter without any need for a prescription I went along and got them there. I asked the young pharmacist if there was any need to finish out the course as I had always being brought up to the idea that antibiotics had to be taken as a full course.

The young pharmacist said not at all, just take one every eight hours until you feel better and as it happened I felt much better after taking just two and I was wondering if I should even bother taking a third, I took the third must admit that I told the pharmacist that I also intended to take a few whiskeys which I did. On the following day the inflammation on my gum was completely gone. But I was so wiped out that I could hardly get out of bed, now let it be said that I did not overdo the whiskeys, just three in all.

The antibiotic in question was "amoxicillin 500 mg/125mg" huge big lump of penicillin in a carton of 30 which I believe if all were to be taken they were strong enough to kill a horse.


Just wondering are there different opinions on finishing out what's supplied in a carton?

May I emphasise again that I am not looking for advice but would be interested to hear views on the subject.

Just for the record to my opening post of 29/11/2013. I took just three of the antibiotics in question see my further posts for full clarification. And now one week later my gum has completely healed. You know I would trust a young Spanish lady pharmacist just out of college more than I would trust a recently graduated Irish doctor who has been brain washed directly or indirectly by the Irish Pharmaceutical Industry!