
Obtaining Antibiotics without a Prescription (2002) - wikiburner
http://www.nejm.org/doi/full/10.1056/NEJM200207183470319
======
davak
ICU doctor here.

I frequently see complications of overuse of antibiotics. C diff colitis (1)
is certainly the most obvious, but resistant pneumonias and urinary tract
infections are becoming more common as well.

Many resistant organisms set up shop in chronically ill patients who see
multiple rounds of antibiotics through their lives; however, in just my short
10 year history as a physician, the increasing amount of resistant
staphylococcus (specifically MRSA) and VRE (2) found out in the community has
changed how we treat many suspected infections.

Although some of this is due to overprescription by the healthcare profession,
there are likely other selection components in our environment. Just as you
can buy these antibiotics for animal use, so can people raising livestock. The
FDA realizes this is a problem. (3)

Personally, the sad part to me is that our medical system is so expensive that
treating routine, mild infections can cost hundreds of dollars. Thus, people
search out these alternative riskier, but cheaper methods.

(1)[http://en.wikipedia.org/wiki/Clostridium_difficile](http://en.wikipedia.org/wiki/Clostridium_difficile)

(2)[http://switchboard.nrdc.org/blogs/slyutse/resistance%20graph...](http://switchboard.nrdc.org/blogs/slyutse/resistance%20graph.jpg)

(3)[http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm378100.ht...](http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm378100.htm)

~~~
conductr
Curious: Do these problems exist in other countries where even strong
antibiotics are sold OTC?

I would guess not as bad, the culture in the US is to medicate immediately at
first sign of illness. When I get sick, I try to just let it run it's course.

~~~
nathanvanfleet
Or does it exist in places where medical care is cheap or free (Canada or the
UK)?

~~~
Fomite
Having recently been to an international Epidemiology conference, I can say
that there's intense interest/concern from researchers in the UK and Europe
about both MRSA and carbapenem-resistant Enterobacteriaceae.

For that matter, the current strain of _C. difficile_ which is causing so many
problems was first observed in the UK and Canada.

~~~
tommu
Was it first observed and reported in these countries because they have
socialized healthcare?

~~~
Fomite
Unlikely, as surveillance for _C. difficile_ is pretty intensive in the U.S.,
and it was reported there shortly thereafter (which isn't particularly a
surprise).

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noonespecial
Notice our friend was already in a world of hurt by the time he went for help.
Not only had he likely made his infection worse by helping it build tolerance
while misdosing random antibiotics, even if he hadn't, he made it worse by
waiting to get professional care.

Antibiotics are a balancing game of just the right dose. I suppose vet
medicine is better than nothing at all in dire straights but if its at all
possible, see a people doctor. They're good at that sort of thing.

~~~
guard-of-terra
But on the other hand he skipped going to a doctor and maybe paying for the
privilege.

I think he should have right to bet on it. Most times he will win.

I think that most limitations on sale of medications are bad for people and
should be lifted.

I'm also not so sure that people doctors are so good.

I fail to understand how commanding people what to do with their own body is
suddently okay when it comes to medicine.

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mberning
I have successfully diagnosed and treated MRSA and upper respiratory
infections in myself. I NEVER suggest anybody else to self medicate. Most
people do not take it seriously enough or do enough research to self medicate.

All that being said, I think it is a shame that we live in a system where it
is so expensive and inconvenient to see a real doctor that people resort to
this kind of thing.

~~~
carbocation
By what means did you self-diagnose MRSA? At a hospital, that would involve a
Gram stain / culture/speciation / sensitivities and take a few days.

Gram stain, because it's very fast (minutes) and can tell you, e.g., that you
have Gram positive cocci in clusters (thus, likely _staphylococcus species_ ).

Culture, then, to grow the bugs and see what nutritional requirements they
have and what biochemical modifications they make. Catalase producing? Likely
_staph aureus_.

Finally, sensitivities: resistant to oxacillin? _MRSA_.

One could imagine PCR-based tests, too, though at my institution such a test
is not in use.

Getting back to my question, how did you successfully self-diagnose MRSA?

~~~
apendleton
A really determined person could probably do almost all of those at home if
they really wanted to, with the exception of the sensitivity test and PCR. A
makeshift incubator wouldn't be that hard to fashion, TSA plates are cheap,
gram stain kits are relatively cheap, and you can do a catalase test with
hydrogen peroxide. I guess you'd need a decent microscope, but the
hypothetical person that's gram staining their own cultures at home surely has
one, right?

So the MRSA diagnosis is hard to swallow, but getting to staph aureus might be
doable.

~~~
carbocation
Totally agreed; I don't doubt that anyone on HN _could_ do this in their own
apartment with the right tools. Many HNers probably have done this in bio lab
back in high school or college. I'm just doubtful of the actual _claim_ of
self-diagnosis of MRSA.

~~~
Blahah
edit: misread your comment, nvm

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ds9
"Since these medications are not regulated for use in humans, there are no
guarantees as to their quality or potency."

Also no regulation as to how they are used. Super-bugs are being bred by over-
use, and a careless or ignorant individual can make his/her own infection hard
to kill by using antibiotics in other than the approved way (e.g. not
finishing the course).

~~~
Tyrannosaurs
It's not just that. Not all anti-biotics are suitable for all infections -
treating a skin infection and a gut infection will tend to require different
anti-biotics.

Self medication is possible and, with enough research, can be done
successfully and responsibly, but for most people it's really not a good idea.

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ClementM
The fact that so many people are looking to get drugs without a prescription
makes me reflect on the accessibility to healthcare in this country....

~~~
msandford
The folks in the special forces community have access to doctors. They're in
the military. There are doctors in the military too and their whole job is
looking after soldiers.

If you really want to get right down to it, why are guys in special forces
(arguably reasonably smart, also evidenced by their figuring out this
antibiotics trick) NOT going to see an army doc right away?

If I was going to be a really snarky asshole I might suggest that perhaps
because it's a single-payer system the quality of care isn't that great and
blah blah blah. I don't really believe that but arguments can be made both
ways.

Don't be a troll.

~~~
a3n
I think maxerickson over in another subthread hit it on the head, "Active duty
special forces is likely more worried about keeping a clean medical history
than expense or inconvenience." These people are by definition and filtering
hyper-motivated.

More generally, what makes sense for your career sometimes negatively affects
other areas, but we tend to protect our careers.

------
efermat
Here in Brazil, if you're friends with the pharmacist, this is easy.

~~~
teddyh
So what you’re saying is that Brazilian pharmacists are more corrupt than
others.

~~~
lnanek2
Well, as an American, I was going to say friends with the vet. There's lots of
potent horse medicine out there as well :)

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mrfusion
This actually might be good for my grandparents. They live pretty far out from
the nearest town and during storms in the winter the roads can be blocked for
a week or more. It seems like this would be something good to have in their
first aid kit.

Are there antibiotics that keep well and are good for general infections?
(Purely as a last resort if there's no way for them to get medical attention)

~~~
dannypgh
A very large percentage of infections are viral and antibiotics would be of no
use. Hence the reason antibiotic abuse in humans is so common.

I suspect antibiotics in livestock/food supply are an even greater contributor
to resistance, because they are used as preventative medicine in that sector,
but really, neither is good.

~~~
adaml_623
So are his grandparents going to catch a cold from the trees? If they don't
have contact due to blocked roads then I think they can rule out viral
infections?

Or have I forgotten something.

~~~
potatolicious
Can't rule it out. You don't have to be showing symptoms to be a carrier, and
you can be a carrier for extended periods. It's quite possible (in fact
likely) that there are plenty of virus sources waiting to get you, including
inside yourself.

------
spindritf
_July 18, 2002_

Has anything changed?

~~~
brianpgordon
Nope. I bought (fish) amoxicillin for my first-aid kit a couple of weeks ago.
It says USP pharmaceutical grade, and the pills look exactly like Google image
search says human amoxicillin looks. I suppose since it's unregulated they
could be putting sugar or arsenic or something in the pills, but I'd imagine
they'd be in hot water with some pissed off fish owners if that were the case.

------
drivingmenuts
Before I had health insurance/well-paying job, buying fishmox was the standby
plan if I needed antibiotics. It occurs to me now that, even though I haven't
taken many antibiotics in my life, it wouldn't matter - the bugs I would catch
would be from other people and would have built up resistances to whatever I
took.

Unfortunately, I told my mom about fishmox a long time ago (during same salad
days) and now I sort of wish I hadn't. It's her standby plan and I'm not
likely to be able to convince her otherwise.

~~~
GrinningFool
"the bugs I would catch would be from other people and would have built up
resistances to whatever I took"

This seems to imply an assumption that all bacteria are resistant, when it's
my understanding that this is actually a small [in relative terms] but growing
phenomenon.

~~~
drivingmenuts
True, but given my limited antibiotics exposure (I just haven't had to take
them much), the chances of getting a resistant bug from someone else are much
higher than my getting a resistant bug from nature (which I have limited
exposure to now).

I probably could have phrased it better. Blame lack of coffee.

------
timini
This "common knowledge amongst all branches of the american special forces" is
going to be a breeding ground for resistant strains.

~~~
math
Yes... Also, you can get anything you like over the counter in Cambodia and
presumably other less developed countries ... good luck to anyone trying to
regulate that.

~~~
brianpgordon
Cambodia? It's well-known that if you want something without having to see a
doctor, you can just drive over the border to Mexico and pick it up from a
pharmacy. Obviously you can't get serious narcotics but you can certainly get
antibiotics, prescription-strength toothpaste, etc.

------
viach
That's weird. I can easily buy erythromycin in the drugstore. I thought this
drugstore was for humans, well, I have never checked...

~~~
carbocation
The FDA only regulates drugs in the United States. Presumably you are located
elsewhere, or if you are in the US you are likely referring to the same
phenomenon described in this paper.

------
TheCondor
Why do special forces guys need to get medicine this way?

~~~
jamescun
A guess would be that obtaining medication in an official way may affect them
when it comes to selection relating to field readiness. I.e. if you are being
prescribed anti-biotics it may be showing that you aren't in peak fitness so
may get passed over for other fitter team members.

~~~
tspike
There are so many hidden penalties for seeking medical help. When I went
through a bad breakup, I saw someone and he thought a mild antidepressant
would help. I saw him twice and took the medication for 9 months.

Almost four years later, I'm trying to get a pilot license for recreational
purposes and now I have to admit to having had a mental disorder, get written
statements from all providers, and go through special review from the FAA. I
can't imagine what a special ops guy or airline pilot would go through.

That's not even mentioning the hell I went through for pre-existing conditions
as a result of this prior to the ACA.

There are very strong disincentives to seek treatment.

------
bananacurve
Bugs and Drugs gives good local info.

[http://www.epocrates.com/e/BugsAndDrugs](http://www.epocrates.com/e/BugsAndDrugs)

------
mynegation
Or go to India, or Russia. Antibiotics are sold over the counter and (at least
in case of India last time I checked) are dirt cheap.

~~~
maxerickson
A lot of antibiotics in the U.S. are basically free. For instance, Walmart has
a $4 prescription program:

[http://www.walmart.com/cp/PI-4-Prescriptions/1078664](http://www.walmart.com/cp/PI-4-Prescriptions/1078664)

Lots of other places have similar programs/prices.

So the expensive part is getting the prescription.

~~~
nanidin
The final uninsured cost being closer to $100 :(

------
ffrryuu
Garlic, colloidal silver, MMS, etc...

------
af3
Biseptol (Trimethoprim/sulfamethoxazole):

Amazon: [http://www.amazon.com/Biseptol-Co-
Trimoxazole-20-tabs/dp/B00...](http://www.amazon.com/Biseptol-Co-
Trimoxazole-20-tabs/dp/B00C7DUIHI/)

Wiki:
[https://en.wikipedia.org/wiki/Trimethoprim/sulfamethoxazole](https://en.wikipedia.org/wiki/Trimethoprim/sulfamethoxazole)

Where is the news?

------
squirejons
I predict that the corporate media will run with this story and that as a
consequence this source of medicine will soon disappear.

We cannot have the profits of our Most Holy Corporations drop. Cheap
antibiotics will cause a drop in the Most Holy Profits of Our Sacred
Corporations, and That Is Not Permissible.

~~~
pessimizer
>Cheap antibiotics will cause a drop in the Most Holy Profits of Our Sacred
Corporations

The opposite is true: with bacteria resistant to ancient antibiotics that are
out of patent and work in weeks, the only alternative will be treatment for
months or years with heavily patented drugs of dubious effectiveness and long
hospital stays.

Is that your preferred outcome?

~~~
Fomite
Not to mention treatment for the side effects. Our last ditch antibiotics are
_not_ gentle drugs.

