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Prophylactic antibiotics

bensonblues at comcast.net bensonblues at comcast.net
Fri Apr 14 17:14:00 BST 2006

Dr. Rick,

The text is 1996, so it is a decade old. I'm very sorry to quote from the archives. It sounds like you are saying that in order to prove benifit, we need a controlled longitudinal clinical study of significant power. I agree with you, but doing the study? In Wayne County (and elsewhere), let's say you don't give A/Bs and patient gets septic and dies. Somewhere there is a retired surgeon with an impressive CV (before he began drinking and developed his gambling problem) that will testify to a jury of 6 laypersons (not peers) that the patient would have lived if A/Bs were given, facilitating a judgement against he physician. Again, you may be right in saying that simply because someone says this is so does not constitute evidence of benefit, but citing this text to the jury is enough for them. Proving that giving prophylactic A/Bs actually harms the patient, well, that's another story. We never used to give A/Bs for puncture wounds of the feet, but a generous award to a patient who d
eveloped osteomyelitis changed that...

One may ask why we rarely see rheumatic heart disease in this country. To prove the impact of the routine administration of antibiotics for otitis, pharyngitis, and URI to our children (which are most often viral) on the incidence of this disease would be impossible. Yet, this begs the question as to why RHD remains relatively uncommon.  

One last note: It is obvious that you are very bright and experienced, and no doubt your brilliance exceeds that of the common physician. Your words will have far more meaning if you avoid the arrogant adjectives which permeate your text. Truly, if you work in a teaching environment, compassion and tolerance of ignorance will make you a far better teacher, rather than someone whom the residents will try to avoid because of the likelihood of being humiliated by your dissertations. I mean no disrespect, as your knowledge and skill as a thinker is unimpeachable; but your crude and condescending comments mitigate against meaningful discussion. That is, of course, this is what you desire.

"I play with microbes. There are, of course, many rules in this play...but when you have acquired knowledge and experience it is very pleasant to break the rules and to be able to find something that no one has thought of...." Alexander Flemming, 1945.


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