This video made me learn a lot about my antibiotics and now I am contemplating whether I should be concerned about my frequent antibiotic prescription given for my almost monthly swollen&bleeding gum, or the fact that I need second root canal treatment asap
Bill seems so incompetent that it makes me feel like I could take his job as long as I have internet connection to google. Like I diagnosed my cat with laryngitis 2 weeks ago using google, she seems fine now. Guess I saved a checkup to the vet. Last year my husband thought the cat was just molting but I suspected she had an allergy or mites. Took her to the vet, and he suspected flea allergy. Vet gave the cat some injections daily for a week and she's been on hypersensitive food diet ever since. Her belly is still kinda bald, but that I suspect is because she keeps stealing food. She's very stealthy and committed to her non-wellbeing. Croissants, toast and chips are her fave and raw meats of course. Her creativity in stealing and tricking us is amazing, such a small brain but so sneaky, she may actually be a raccoon trapped in cat's body.
Remember kids: The doctor with one sunglass is the infectious disease specialist. The doctor with 2 sunglasses is the radiologist. The doctor wearing a sunglass with flowers on them is the dermatologist arriving from his third vacation in a single month.
Dude that derma you're talking about must be busy af. Usually they already live in a beachfront in Malta sipping coconuts all day in their bikinis (and SPF 6250 sunscreen of course) and get consults over the internet.
Used to be a tech working reconditioning, repairing, and building RF linacs and I was the first dedicated tech that shop had gotten since the late 90s, cleaning up over a decade of scientist clutter was a seriously important part of that job! Keeping any lab running smoothly and safely is an unending battle, and when radiation is involved it all gets so much worse. Respect over to you folks doing that work over in medicine directly!
To all the people who are confused about Flagyl/metronidazole for anaerobic cover joke; when the term "anaerobe cover" comes up, it generally mean we are treating multiple bug infections and you want to cover the anaerobes as well as the gram pos/neg. It also mean the patient is already on ANOTHER antibiotic and doctor wants to ADD metronidazole to an existing antibiotic/s regiment. In most cases, that other antibiotic/s ALREADY has anti- anaerobic properties! You DO NOT need double anaerobic cover unless you're treating c.diff or necrotizing fasciitis. A lot of doctors seem to think that anaerobes must be treated with metronidazole, which to be honest, just goes to show how well Pfizer had done in promoting Flagyl.
The main thing I took from this video is confusion over prescribing metronidazole… Tried flicking through the comments rather than publicly displaying my ignorance m.
Pfizer is half drug company, half ad agency. Fun fact I learned from the book Empire of Pain, Pfizer was one of the first customers of Arthur Sackler's ad agency, promoting a new antibiotic to "doctors" by taking out a full page ad in the New York Times. The antibiotic turned out to be mediocre, but sales were still through the roof. I strongly dislike Pfizer.
@@falconerd343 IS there a drug company significantly more ethical than others? At the end of the day they are profit making company. They take on the risk and investment of generating new medicines and need to be able to charge for them and advertise them. The system itself is broken. In the UK we have a nationalised health service working in silos with individual deals with various firms. It needs centralising and a nationalised drug and research service. We could lead the world, and cut back on masses of duplication across the industry.
Considering that metronidazole is a thiazole and destroys thiamine throughout the body, and 1 in 400 people deal with serious adverse reactions resulting is dysfunction and/or damage to the brain and/or nerves due to its toxicity...maybe don't prescribe it for every damn thing.
Thanks captain. I'm getting tired of reading metro reviews thinking metro doesn't cover anaerobic germs lol. Still sad how many times I see tazocin clyndamicin on patients Oo
That antibiotic stewardship is true af. The infectious diseases professor who taught us microbiology used to get personally offended when my dentist ass answered all treatment questions with amoxicillin or ceftriaxone. Dude's face would start twitching lol
@@Rakkeyal lol no, as long as it was actually tested as strep throat. Currently there is still way too much, “oh, you have a sore throat? Antibiotics for you!”. Even strep throat may eventually be managed without antibiotics, except in very specific cases, as the evidence for their use and their effectiveness in actually preventing long term complications from strep throat is coming into question.
@@Rakkeyal thats not flaky at all. Amoxicillin is an appropriate choice for strep throat. The standard of care is still to treat strep with antibiotics. I was just noting that eventually we may come to a time where we dont.
Reminder: I can buy Metronidozole (for fish) in any quantities and it sure sounds like a great thing to stock up on. I think I'll hand it out like candy for people with sniffles. Just in case. You can't stop me. But hey... listen... you prescribe me a variety of human grade stuff on the DL that I can't get my hands on outside of a trip to Tiajuanna and I'll promise to start at the bottom of the ladder with those. I wonder who might be ready to bend the law to be a good steward
@@peto7020 I think the comments kind of getting away from the video. I’m curious about how pharmacists feel about antibiotics in the Agriculture industry because they are one of the largest global consumers of antibiotics. When we talk about superbugs and antibiotic resistance, human medical practices come to mind. But other industries like the Animal Agriculture industry also exasperate the problem.
My mother hoards “left-over” (aka, she didn’t finish her course) penicillin, and forces people to take one if they have a sore throat because “colds are viral but coughs are bacterial”
@@Svenne-man-1880 I’ve tried, she won’t listen to me. Or to any of the sources I’ve shown her, including all of the NHS posters about antibiotic resistance she sees in the A&E waiting room to pick up some more penicillin for a high-fever cold.
Why do I feel that the attending was the one who wanted Mero but sent Bill to do the dirty work because he didn't have any proof to back up the need for Meropenem?
As someone who is frequently given antibiotic prescription for bacterial infections, this skit also pokes on my anxiety 😂 The ever growing abscess in my gum is not helping either
As a 4th year pharmacy student who recently completed a rotation in the ICU, this skit made me laugh and gave me anxiety all at the same time. I can still hear my preceptor asking the resident why they wanted Mero when Erta and PipTazo hadn't even been considered yet.
Patients play a role in antibiotic stewardship too. Everyone please take your medication(s) as prescribed, do not miss a dose because you will need to be treated longer than necessary. And never increase your dose without a doctor's order - the antibiotic will not "work better" if you take more of it at once. There's a lot of consideration that doctors take when deciding the dosage and timing for medications, please ask them questions so you can understand their reasoning.
Meanwhile my mum will not finish her course, hoard half-filled boxes of penicillin, and force people to take one if they have a sore throat because “colds are viral but coughs are bacterial”.
Same logic applies to animals. Give your pet it's medication as prescribed, the full treatment. Don't change the dosing without consulting your veterinarian. You would not believe the number of animals we'd see with wounds and infections that "just won't heal" because the owner would stop giving the meds after a week since 'they got better" then be back three weeks later because the infection never truly cleared and we have to start all over again.
I become inordinately proud when I consult ID and I can hear the silent (non-existant?) approval I get when I ask if I can change a broad spectrum to a combo of several narrow spectrums... it's better than sex lmao. "We taught you well my child" vibes.
This is literally the first time I've ever posted a comment on youtube. As an intensivist, the last few years have been awful to say the least. But you have been a consistent source of comedic relief in an otherwise ridiculous world. Thank you for what you do. Next time I need mero maybe I'll put on some sunglasses and pretend to be ID.
Can we put this on loop on the TV in the lobby of my urgent care so Karens with their 2-day sinus infections stop yelling when I don't give them Augmentin?
You have folks who come in after 2 days? That would be a dream. We're starting to get people saying I've had a cough for.... and then even they catch themselves in embarrassment and admit it started a couple of hours ago. Seriously?!?!?!?!
I am a retired pharmacist, 30+ years in retail/community pharmacy and I too, appreciate the antibiotic stewards out there! And thanks Dr. G for including pharmacists in the fun!
Only time I've actually seen the radiologist as a patient was when I had an adverse reaction to contrast dye... He seemed freaked out. Meds and fur a-flying!
I used to think doctors and medical students around the world are different. But the more I see you the more I realize that we all are studying an universal subject. We face the same difficulty and problems around the world.
This one hits home. Had a hospitalist or at least I thought it was a hospitalist, order remdesivir for a patient that didn’t meat criteria. Told him we couldn’t approve without ID approval. I kid you not his response was, “I am ID.” Order was verified.
@@1habiit you're right, it goes into solution really quickly, but our hospital prefers us to draw diluent out of the bag equivalent to the reconstituted volume. It's fine if you're doing a bag or two, but we get like, 20 orders at a time lol.
@@dfeuer Sure! Pharmacy technicians working in inpatient pharmacy prepare the intravenous medications that go to the nursing units. It's technical work we do with our hands using needles and syringes. The repetitive motions of drawing and pushing fluids in and out of saline bags can strain our hands and wrists. I'd say most of us have some degree of carpal tunnel syndrome lol. Meropenem is especially a pain, at least in the hospital I work at, because we have to draw saline solution out of the bags before injecting the drug in order to prepare the correct concentration. A one gram dose requires me to draw 20ml of saline out of the bag first, then reconstitute the vial with 20ml of sterile water, then mix until it is in solution, then draw the meropenem out of the vial and inject it into the bag. A two gram dose is 40ml, so larger, more cumbersome syringes are used. Like I said in another comment, this isn't so bad if you're only preparing one dose, but I work in a very large hospital so we get around 20 orders per batch (two batches per shift, so ~40 doses going out a shift). This is only for one drug too. There is a _lot_ more we dispense of course, meropenem is just especially tedious and straining on the hands.
(Fellow CSP tech here) we have the luxury of mini-plus bags for 500mg and 1g meropenem orders, and honestly I’d never considered how lucky I am to not have to compound those every cart fill 👀
Hello Dr. Glaucomflecken, I will call you as Dr. Glaucomflecken because i recognized you with that name first. I am Berra and i am a 3rd year medical student. I am just the person who is on the other end of the world. I have never met with you, i have never seen you in real life. But i explored your very cleverly prepared videos and i had fun a lot. Even if i am not in the same country with you but i understand jokes, i laugh at them. And this emotions made me feel that i am a part of medical community. And that sense of belonging, connected me to my job again. So you just didn't make me laugh with your videos, you created a big awareness that i am really lucky to be a part of medicine. I can't thank you enough for this emotional support. I wish you and your family a happy and healthy life. Yours sincerely.
Good one! I die inside when family members save some of their prescribed antibiotic treatment because "then they have some for the next time they feel sick" 😭
I work in a pediatrician's office. We had a mom bring her kid in for suspected strep, but she'd already given him a couple doses of some random amoxicillin prescription she had lying around 😫 so not only was it impossible to find out if it was actually strep, but her children are probably carrying superbugs around wherever they go...
I'll keep unused meds around till they expire, but won't use them unless a doctor tells me to. Potentially saves a trip to the pharmacy when sick as a dog. (I only have unused antibiotics if a doc prescribes them but tells me to wait and see X time before using them.)
@@LuisXGP When using antibiotics,there’s a chance that due to low dosage, failure to complete the full course or otherwise that a bacteria develops resistance to said antibiotics. Bacterias can spread the resistance easily by producing more of itself or spreading the resistance gene with other bacteria. A super bacteria is resistant to most of our antibiotics, so if u get sick because of them we can no longer use antibiotics to beat the illness, which is really bad
@@hx5525 That part I already knew, but what I don't know is how potent are the antibiotics that are mentioned in the video. Although by your explanation I may believe that meropenem is very weak, but in my experience the broader the antibiotics, the more potent they are, so that's mostly what I'm confused about it. And why dissease doctor can play with antibiotics is the other thing that needs explanation.
@@LuisXGP Perhaps the boarder the antibiotics the greater the number of types of bacteria targeted and hence the greater the chances of one of them developing the resistance? So it’s best to use more limited/specific antibiotics because the risk is smaller? Idk,not a med student
As a medical lab technician, I can definitely say your infectious disease doctors are the most communicative about antibiotic sensitivity and resistance. A part of our job is the actually growing, identifying, and then sensi testing to tell your doctors how to go about treating your infection! And there’s definitely a growing issue with the bacteria becoming resistant and then it literally shares its resistance with other like bacteria :’)
I’m a pharmacy student who had to do an internship with a hospital pharmacist with an infectious disease residency and this was basically it. Dr’s pretty much let him write the antibiotic orders 🤣
My pet peeve when I was practicing was doctors who ordered medications to patients without explaining clearly the possible side effects. And adult medicine doctors not knowing how to compute the dose for pediatric patients and simply guessing or passing on to Pedia.
@@noellelavenza494 yeah 😂 According to all prof in universities, wiki is a bad source of information. If Dr's start using wiki to decide dosage for baby patients, that could be risky 😐
@@ClearlyPixelated Yea, but who has the patients weight in kilograms at their fingertip, then you get some crazy number that isn't anywhere near the dosing available or the teenager is over the "max dose" per day and then you are thinking....am I supposed to be giving this kid the maximum dose of an antibiotic for this infection? So you look at specific infections with simple dosing, and say ok lets just give them 3 of this dose per day.
Love the pharmacy inclusion in your content!! Everyone forgets we’re health care professionals too!! Would have any medications without us!!! Also yes meropenem is only for the most dedicated antibiotic stewards 😂
Antibiotic stewards keep us slightly safer in the long run! Now if only each AS had the ability to long-distance mind-slap any doctor who blindly prescribes antibiotics...
Question: what’s wrong with Flagyl for anaerobic coverage? Context: I’m an orthopod who hasn’t ordered Flagyl since internship, so this is a genuine question.
Nothing wrong with flagyl for anaerobic coverage. He is likely referring to common over prescribing of flagyl for ‘empiric anaerobic coverage’ in all kinds of infections where it doesn’t clinically make sense that gram negative anaerobes would be the culprit.
Pharmacist here. Nothing wrong with it! Skit is a bit short. It’s a Zosyn + Flagyl combo therapy reference that drives pharmacists and ID docs crazy. Zosyn already covers anaerobes. 99% of the time this drug combination is inappropriate, but even after explaining the anaerobes are already covered by Zosyn, you can’t talk the ordering doc out of the Flagyl. Patient is now nauseated. Doesn’t want to eat bc everything tastes gross, and the nurse is tired. Carbapenem+Flagyl, also not necessary. Unasyn+Flagyl super dumb bc now you’re prob not covering EColi due to wide spread resistance and you’re double covering anaerobes.
I think it's because the primary antibiotic like Zosyn or Carbapenem already covers anaerobes. So it's duplicate therapy essentially. In fact, it's probably easier to list the common antibiotics that do not cover anaerobes. Quinolones and cephalosporins are kind of suspect to rely on. Aztreonam too.
@@TheRayfield77 ^^^This. In most situations, there's no need for additional coverage. Occasionally, there's a good reason to do it, but it shouldn't be an ass-coverer
So funny and interesting to read reactions from all over the world from people who recognize so much from this video! (I'm a pediatric resident in a european country) I wouldnt dare to prescribe meropenem unless it was adviced by ID or microbiology lol
When the pharmacist guy said "Really?" he suddenly sounded like the therapist. It's amazing how a single word said in a specific tone by the same person makes it seem like a different character entirely.
As a med tech turned PA-C, this was fantastic. I talk people down from antibiotics for about 50 percent of my patient interactions. Suddenly everyone is an ID specialist when they come to UC. And why does everyone want azithromycin? It's a Z in the word right? Sounds "sciency"?
I had to show this to my in-law who’s a pharmacist, and he said he’s past the antibiotics stewardship 😂 I wouldn’t doubt him, he’s a very wise and smart man. And he agreed to this 100000000%, he’s 60+ but he laughed so hard watching your video 😂
"Have you consulted your antibiogram?" "I..." *searches inside own shirt* "...don't have one" the judgmental head turn at 1:19, "stop trying to destroy the human race", and the swagger of Infectious Disease and Pharmacy's hero worship 😂 Your facial expressions are top tier comedy
I remember years ago I was prescribed a new antibiotic specifically for UTIs. Didn't do a darn thing and the doctor changed me to Amoxicillin which worked like a charm. Amoxicillin was given for everything back then lol. Congrats on 500,000! Knew your channel would take off because it's too good not to!!
@@FirstLast-pt7bm Outdated advice. Longer courses are almost always unnecessary and promote resistance. We're past that advice nowadays. Also, UTIs in women generally shouldnt be treated with antibiotics. Only if they are considered a risk. Antibiotics are extremely overprescribed for infections that dont require treatment
@@user-tb5fc6yr7o The general physician in my locality prescribes me antibiotics for each and everything like viral fever , cough and cold, bad bug bite. I hate going to that Dr 😑
@@user-tb5fc6yr7o ok but that's a doctor's decision, not a patient. The doctor is gonna know more than the patient about the specifics of their infection. Stop giving medical advice in youtube comments discouraging taking antibiotics as prescribed.
We have an "old school" urologist who will collect and plate cultures in his office (most of the time they are contaminated with oral flora), try and order exclusively Ciprofloxacin, and wants staph epi worked up Every. Single. Time. He also drives a Corvette with "doc" on the license plate and treats anyone without a doctorate like crap.Beleive it or not He is the most hated doc at our hospital, but hey he is a major foundation donor so...
@@kingofallworlds The worst episode of agitation I've ever seen was an elderly man admitted after starting Levaquin. Agitation is putting it mildly. He was out for blood; it took 6 nurses to hold him down so he could be restrained. Three lying on top of him -- upper, mid and lower body -- all of whom he kept bucking off into the floor. To their credit they kept climbing back aboard. It was brutal Biting, hitting, kicking, screaming. I always wince whenever I see that ordered in older folks.
How do you routinely get oral flora in urology samples? (I mean, I guess unless the patients were up to some specific activities directly before he took this specimen....?)
The first mentioning of meropenem triggered an angina I didn't even know I had. I shame every other doctor for using broad spectrum antibiotics (always amoxiclav 2id) to treat pulpitis on young healthy patients with no cardiac pathologies on a regular basis, can I be a steward as well?
God this is relatable. I was put on some new (and hella expensive) antibiotics that had like 30 possible side effects (i got at least 4 and later dropped out because of them). I even heard that one of my mom's friends had to go to the hospital because of that antibiotic. Bless those who keep a watchful eye, makes our lives so much more safe
I love taking prednisole, because all my symptoms go away in a few hours 😊 But obviously then I start having anxiety about the side-effects of course. Double ended sword if there ever was one.
Me; a Paramedic in rural America: "Hey we're here for the transfer." Community Hospital ED Nurse: "Oh hey, yeah they're septic going to St Elsewhere's ICU with an antibiotic and fluids running." Me: "What antibiotic?" Nurse: "Vanco." Me: "Why Vanco?" Nurse: "The doctor ordered it because they're from a nursing home." Me: Nurse: Me: "I'm going to spend the trip hoping this finishes before we get to Big City so the ICU nurse doesn't yell at me about superbugs."
If someone's septic and needing fluids to maintain BP, I'm surprised anyone's yelling at you for having them on empiric Vanc until cultures come back, especially an elderly patient from a nursing home. There are cases when you hold back, then there are cases when you'd rather the patient live than worry about resistance.
@@j_skye7291 No lie, ICU nurses have expressed their frustration to me numerous times about our community hospital sending “everybody” to them on Vanco. End of the day, doctor orders it, I take it.
I was once a junior on an ortho rotation and we treated a patient for an asymptomatic UTI post-op with Tazocin for 28 days. The microbiologist was consulted only after the patient became neutropenic and feverish and the ortho consultant wanted something stronger. We stopped all antibiotics and they got better. Micro was livid!
i am a medical student just went through pharmacology and microbiology..... Shit what did your collegues think!! thats such a potent antibiotic for something asymptomatic!! That ortho consultant needs some basic pharmacology retraining!!
