November 17th, 2010

Ferlater Antibiotics

danishIn this absolutely hysterical, laugh-out-loud comedy routine, Mal Z. Lawrence describes a woman at a Catskill hotel, piling danish into her handbag.

She calls them “ferlater danish” — as opposed to the ones she’s eating at breakfast, those are “fernow.”

Did you ever have one of your patients request “ferlater” antibiotics?  That is, ask that you write a prescription for an antibiotic even though they’re not sick now, just in case they become sick?

Over at the “The Ethicist” column this week in the Sunday New York Times, Randy Cohen fields a question from a woman whose husband has just developed pneumonia on a trip to Peru, even though he’d requested (and had been refused) antibiotics from his doctor before he left.  “Was the doctor overly rigid?” asks the woman.  Responds Cohen:

This doctor does seem disturbingly conservative…  So, yes, I’m with you, and so is Dr. Jane O’Shaughnessy, an expert in emergency medicine, who e-mailed me to say, “Prescribing antibiotics and other medications tailored to the trip destination is usual practice among doctors who specialize in travel medicine.”

On first glance, this seems right, especially since the man had a history of recurrent respiratory tract infections.

But Mr. Cohen and Dr. O’Shaughnessy should know it’s not always quite so simple.  First, travel medicine and ID  specialists — and I wonder why Cohen asked an ER doc rather than go right to the source — recommend providing antibiotics before trips to developing countries in case diarrhea develops, but not in general for respiratory tract infections, most of which are viral anyway.

Second, let’s say he did get the antibiotics — would this have necessarily prevented the pneumonia?  Who’s to say?

Third, it’s important that Times readers know just how often clinicians get asked for “ferlater” antibiotics, usually with far less justification than in the anecdote presented in the Times.

And rather than displaying excess rigidity, doctors and nurses who say no to this request are generally acting with very sound judgment.

One Response to “Ferlater Antibiotics”

  1. Gary Evans says:

    I love your blog, Dr. Sax. As a patient with a recurring, severe, and almost annual challenge by Mycoplasma, I do indeed obtain a Z-Pak (macrolide) and another antibiotic not in the macrolide family for self-administration. As a wanna-be immunologist, I am keenly concerned with inducing resistance to the macrolides which were my last-resort when this bug almost killed me. My docs know my history, my education, and my conservatism so this arrangement has been wonderful from my perspective. But I do anguish when I hear people using antibiotics as preventatives before-the-fact. This is an evolutionary disaster, even when it may be the saving of an individual.

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

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NEJM Journal Watch
Infectious Diseases

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