From: ((Steven B. Harris))
Subject: Re: Organic germanium
Date: 07 Jun 1995

In <00391802.fc@pop.com> p_iannone@pop.com (Paul Iannone) writes:

>You admit things, but your subsequent disclaimer isn't as elastic as you
>think. I am not opposed to antibiotics--I AM OPPOSED TO MISUSE OF
>ANTIBIOTICS.

Gee, me, too.  The problem is that the risk from an antibiotic (small)
becomes greater than the benefit (potentially large) at somewhere along
the line from 0% chance of bacterial infection at any given site in any
particular person, to 100% chance.  I'm sure I don't know where exactly
that point is, but I when my estimation is that a bacterial infection is
more likely than not, I usually either offer or recommend an antibiotic.

I'm quite sure YOU don't know exactly where on this line the benefit of
an antibiotic outweighs the risk, but making this critisim of medicine
implies that you think you do.

> You admit this is done--I submit to you that HMO's do this all day
>long.

Why should they?  It's sure not profitable.  The most profitable thing
to do with someone who looks and sounds like he has a viral upper
respiratory syndrome is to treat for that and same the antibiotic money
AND the culture money.  If you tell the patient the signs of bacterial
secondary infection and they know they can always get an antibiotic if
they need it in the next few days, simply by phoning, they're usually
satistified.

>I and others have gotten hundreds of reports of this from clients who had
>subsequent illnesses directly traceable to mistreated colds. You're
>excusing away malpractice.

Yeah you probably have.  And you have no way to evaluate such complaints
for either acuracy or validity.

>Your idea that it is harmless is unfounded, unverified. You just
>think it is harmless.

Relatively harmless.  I don't know of too many human activities which
are absolutely harmless.  The question is: at what point is withholding
the antibiotic more harmfull than giving it.  Sometimes difficult to
answer with the individual patient.

Here is a helpful example. At every hospital they monitor the ratio of
infected appendixes removed to the number of normal ones removed (which
they always do when they go in after a supposely inflammed one, and find
nothing).  If the fraction of normal appendixes gets too large, they
advise the doctors they are doing harm by opperating too readily.  If it
grows too small, they advise the doctors they are doing harm by not
opperating readily enough (thus insuring some fraction of ruptured ones
before opperation is finally done).  The optimum treatment of patients
with suspected appendicitis involves harming a certain fraction of them,
because here the doctor does not have the luxury of doing something that
will harm nobody.  It is rather the same (though with smaller stakes)
with doctors and sinus complaints, although you'll have to think awhile
to see it.  Perhaps you never will understand.

>The point is that you can ridicule a holistic practice (needling the top
>of the head for hemorroids), which does work, has worked, and for which
>an explanation should perhaps be sought by someone of conventional
>physiological science bent-

Sorry, I don't believe it.  The burdon is on he who makes the claim.

>-while being the apologist for a variety of conventional medicine
>misuses.

   I already said that too many antibiotics are used, in my estimation.
 Proving this, however, is another matter.  That's not exactly being an
apologist.

>>That is the complexity of your position--it is not exactly reliable.

   That my position is complex is reliable.  That you will understand
it, is not.

                                                    Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Bronchitis and antibiotics (was: Re: Estrogen not working)
Date: Sat, 13 Sep 1997
Newsgroups: alt.support.menopause,sci.med

In <01bcc02e$ee48ac60$442192cf@vucqpqlj> "Ali"
<aalleylaw@worldnet.att.net> writes:

>Dear Lynn:
>    I hope that you called him back and asked him to please write these
>things down as a reaction. All those side effects had to start from some
>where and just because they say it doesn't interfere doesn't mean it
>isn't so. Look at all the women on this news group only and we can sure
>see the difference in chemicals in the body effecting each other
>differently.
>
>I also question any doctor giving you an antibiotic for a virus...viruses
>cannot be killed by antibiotics and if he gave it to you for your lungs,
>something that hasn't happened yet, then he can be creating super bugs as
>this is how they start.


   I have to second that.  In fact, I will go further.  There is
precious little evidence that antibiotics work on bronchitis (except
possibly in exacerbations of chronic bronchitis in COPD), even when the
infection is *known* to be bacterial.  Most of the best evidence is
that they do NOT.   But they are almost universally prescribed by
doctors for "green sputum."  I've done it myself in the past, but
again, evidence does not support it (as recent studies show).  And it
does contribute to killer bugs.  Step pneumonia was only resistant to
penicillin at 6% fraction of isolates in 1992.  Now, it's running about
30%.   By 2010 or so we're going to be in big trouble with both this
bug and Staph, and it's all due to inappropriate use of antibiotics.

                                      Steve Harris, M.D.

From: jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox)
Newsgroups: sci.med
Subject: Re: Cellulitis
Date: Sat, 20 Feb 1999 17:02:59 GMT

On 18 Feb 1999 17:23:02 -0600, mjenks@annex.com (MSJ) wrote:

>About 3.5 weeks ago I noticed a bump on my right shin about 3/4" in
>diameter.  It was about midway down my calf directly above the bone.
>I didn't think much of it (it wasn't red or swollen, just a bump), but
>a couple of days later it had gotten bigger, and was definitely
>swollen.  To make a long story shorter, I was in the middle of a move
>out of state, was unable to see my doctor before I left, spent 3 days
>in the car driving to our new place, and a few days later made it to a
>walk-in clinic.
>
>The doctor diagnosed it as cellulitis, the area being 7.5x8cm in
>diameter.  He drew a line around the area with an indelible marker and
>prescribed Levaquin (sp) for 7 days.  He told me to come back in 2
>days to have it checked.
>
> [...]
>
>Today, out of desperation, I called my doctor in California.  Her
>nurse suggested I go to a different medical group entirely and get the
>area cultured.  No tests have been done at all and of the three
>doctors, the first two only touched my leg for a cursory feel to see
>how warm it was.  The third poked and prodded and took a good look and
>mentioned a bone scan if it didn't get better.  However, I have no
>guarantee that when I go back to this clinic I will see the same
>doctor, which bothers me.  It's an "immediate care" clinic where you
>can't make an appointment at all and you don't have "a" doctor.
>You're seen by whoever is on at the time.  Judging by the success I
>had trying to find a doctor in the area who would take new patients or
>would schedule them sooner than 2 months out, I'm not sure that I even
>have the option of going to a different group!  Not being able to get
>an appointment anywhere was why I wound up at this walk-in clinic
>which is 30 minutes away.

It is difficult to comment without knowing the whole story, but it
appears to me that your only symptom was the mass on your leg.  No
fevers, and no warmth, redness, or tenderness of the mass?

If this is the case, your situation is unfortunately too common.  Many
physicians make no effort at all to diagnose, but simply prescribe
antibiotics for whatever ails you.  It seems that walk-in clinics, of
the type you describe, suffer the most from this behavior.
Frequently, when a patient presents again with no change in the
presenting symptoms after a course of antibiotics, physicians at these
clinics simply prescribe another antibiotic.

The reason this behavior is so common is because most diseases tend to
spontaneously remit no matter what.  It is believed that a useful
therapy is being intiated when antibiotics are given, and when the
condition goes away, patients consider their money well-spent.
Problems arise, however, when the disease process does not regress and
a revised diagnosis is finally investigated only after a patient has
taken three weeks of antibiotics.  The result is wasted time and
money.

Let me stress that this is not intentionally bad medicine or a
conspiracy by doctors.  Some physicians truly belive that empiric
antibiotics for an asymptomatic mass is the proper way to treat, and
will switch antibiotics over and over again until the mass is gone or
the patient ends up seeking a diagnosis elsewhere.  However, most of
us believe the saying, "In order to properly treat, you must first
properly diagnose."

But let me also make it clear that I do not claim to be able to
properly diagnose any illness on its first presentation.  Also, I do
sometimes prescribe empiric antibiotics for some presenting
complaints.  A swollen, tender cervical lymph node in a child having
fevers as most likely a bacterial lymphadenitis that needs no
diagnostic tests and will respond to antibiotics.  The bad medicine
comes when, in light of evidence that the process may not be a
bacterial infection (either an unlikely initial presentation or a
failure to respond to therapy), no effort is made to revise the
diagnosis.

You have actually identified part of the problem.  As I said, walk-in
clinics where patients do not see the same doctor and there is no
continuity of care seem to suffer more from this behavior.  One of the
most important aspects of initiating therapy for any disease is
appropriate follow-up.  It does seem that the first physician you saw
is aware of this, as he drew a line around the mass and recommended a
recheck.  But if you were able to see the same physician who could
prescribe treatment and then evaluate its effectiveness, you might get
more efficient care.

I don't know what the mass on your leg is.  It sounds like you had a
mass that suddenly enlarged, then broke up and began to shrink, and
now your skin is discolored over the area.  No redness, no tenderness,
no fevers.  My guess is that you had a bleed in that area, and you are
observing the resolution of a hematoma.  Whatever it is, though, I
would also guess that, if it hasn't responded to two courses of
antibiotics already, it's not going to respond to Trovan.

Constructive criticism on my opinions is welcomed.

--
Jonathan R. Fox, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: on to antibiotics...
Date: 22 Feb 1999 01:13:47 GMT

In <36D08346.1A60EA74@vms.cis.pitt.edu> Dr & Mrs Smigrodzki
<srafal@vms.cis.pitt.edu> writes:

>> most powerful antibacterial drug will not do any good. Misuse of
>> antibiotics will be the end of us all, I'm afraid.
>>
>> Ed
>
>
>Since you mention misuse of antibiotics, I will ask a question I
>have presently concerning just that.
>
>I am wearing braces on my teeth. I had an inflamed gum and the maxilla
>(cheekbone, right?) was beginning to be sore just above the gum up to the
>"apple" of the cheek. ( No history of sinus trouble, if it is relevant.)
>So I thought I might have an infection and cavity hidden by the braces.
>Since it was a weekend, my husband prescribed amoxicillin 250 mg for me
>(3X a day) until I could see dentist on Monday. On Monday, an xray was
>taken and showed something, but nothing that could be definitely called
>an infection and no cavity. I asked the dentist if I should continue a
>full course of antibiotics (because I have always heard you must take a
>full course so as not to give nasty infections the opportunity to become
>unresponsive to the antibiotic.) The dentist said no. However, I then
>protested nicely by adding "what about the danger of ...(as above)". He
>said , "oh, yeah, I guess you could take them." So when I got home, I
>asked my husband what he thought. He said I should trust the dentist
>(sorry, but I trust no one without explanation). So my husband prescribed
>another 3 days (for a total of 5) of the antibiotic. I asked the
>pharmacist what he thought. He said one should always take the
>traditional 5-10 days of an antibiotic.
>
>So what is the correct thing to do here? Did my dentist sleep through
>pharmacology class?
>
>          Thanks,
>         Karen S.


    In come cases the answers are not known.  My infectious disease
professor always said we give 7 to 10 days worth of antibiotics for an
infection because God made the world in 7 days in the Bible, and people
have 10 fingers.  I reckon that's not far from the truth.

   You should see a periodontist (gum specialist), since if you have
gum infection, it will be difficult to get rid of without a good
scraping out of the debris which hide the organisms from your immune
system, and from antibiotics.  And do it pronto.  Dental knowledge is
also very large, and has gotten large enough that nobody can possibly
know it all these days.  You've got to start treating them like medical
specialists, and in some cases you need to refer yourself.  Even if you
pay out of pocket.  I've saved several teeth that way.  And, alas, lost
two molars because *I* was unwise.

                                        Steve Harris, M.D.

From: jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox)
Newsgroups: sci.med
Subject: Re: on to antibiotics...
Date: Mon, 22 Feb 1999 03:21:06 GMT

On Sun, 21 Feb 1999 14:05:58 -0800, Dr & Mrs Smigrodzki
<srafal@vms.cis.pitt.edu> wrote:

>          I am wearing braces on my teeth.  I had an inflamed gum and the
>maxilla (cheekbone, right?) was beginning to be sore just above the gum up to
>the "apple" of the cheek. ( No history of sinus trouble, if it is relevant.)
>So I thought I might have an infection and cavity hidden by the braces.
>          Since it was a weekend, my husband prescribed amoxicillin 250 mg for
>me (3X a day) until I could see dentist on Monday.  On Monday, an xray was
>taken and showed something, but nothing that could be definitely called an
>infection
>and no cavity.   I asked the dentist if I should continue a full course of
>antibiotics (because I have always heard you must take a full course so as not
>to give nasty infections the opportunity to become unresponsive to the
>antibiotic.)  The dentist said no.
>However, I then protested nicely by adding "what about the danger of ...(as
>above)".  He said , "oh, yeah, I guess you could take them."  So when I got
>home, I asked my husband what he thought. He said I should trust the dentist
>(sorry, but I trust no one without explanation).   So my husband prescribed
>another 3 days (for a total of 5) of the antibiotic.   I asked the pharmacist
>what he thought. He said one should always take the traditional 5-10 days of
>an antibiotic.
>
>           So what is the correct thing to do here?  Did my dentist sleep
>through pharmacology class?

It is unclear from your post whether there is believed to be an
infection or not.  But generally, if you begin an antibiotic and
discover there is absolutely no way you have a bacterial infection,
you should stop them.  However, if you start empiric therapy for a
suspected bacterial infection and there is no way to prove whether it
was there or not after the fact, you should complete them.

The first scenario is actually less common, so courses of antibiotics
are usually completed once they are started.  An example of a rare
time when I did stop antibiotics:  I saw a four-year-old girl who
presented with Henoch-Schoenlein purpura.  This is an inflammatory
disorder that is not treated with antibiotics.  The diagnosis was
clinically obvious because the characteristic rash had appeared that
morning.  The day before, however, she had nonspecific symptoms and
was seen at a local walk-in clinic, where she was given amoxicillin
for an "ear infection."  The parents and I were both puzzled by this
diagnosis, since the girl had no cold symptoms, no fever, no earache,
and her eardrums were pristine.  So I stopped the antibiotics.  This
was a special case because the unifying diagnosis was now apparent and
the presumed diagnosis of bacterial infection from the day before was
obviously wrong.  (See my prior post on inappropriate prescribing of
antibiotics in walk-in clinics.)

--
Jonathan R. Fox, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: A suggested Solution... Cell Walls?
Date: 10 Mar 1999 09:59:50 GMT

In <36E5C04B.1FCA@cam.org> Dirk Mittler <mdirk@cam.org> writes:

>It isn't obvious that simple bacteria that have no cell walls really
>pose a health-hazard to humans. Our immune system easily destroys
>them.


   Nonsense.  Some of them are just as hard to destroy as HIV, and for
the same reason-- they're inside *your* cells (ricketsia, Staph, TB)
where the antibiotic doesn't pentrate.  On in an abscess which has the
same problem due to no circulation.  Or hiding in necrotic tissue.  And
as for cells with walls, there are all kinds of reasons for them to be
resistant to penicillin other than an enzyme that breaks it down.  They
can have an enzyme that simply isn't inhibited by it.  Or they can have
a transporter than doesn't pick it up to take it into the cell, and is
much more choosy about sugars.  And so on.  Evolution in action.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: A suggested Solution to the Antibiotics Resistance Problem
Date: 10 Mar 1999 10:04:13 GMT

In <36E5BCFD.121A@cam.org> Dirk Mittler <mdirk@cam.org> writes:

>Sorry to be so impertinent, but since all of the antibiotics have been
>established to work through common b-lactam groups,


And by the way, there are all kinds of ways antibiotics work.  Only the
cephalosporins and penicillins and a few related antiobiotics work that
way. Others inhibit bacterial ribosomes (both parts- macrolides,
tetracyclines) or bacterial DNA gyrase (fluoroquinolones) or wipe out a
bacterium's capability to make folic acid, so it dies of vitamin
deficiency if it can't absorb it (sulfa drugs).  Etc.  Do some reading!

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: A suggested Solution... Cell Walls?
Date: 12 Mar 1999 09:49:56 GMT

In <36E858CA.1473@cam.org> Dirk Mittler <mdirk@cam.org> writes:
>
>Steven B. Harris wrote:
>>
>> In <36E5C04B.1FCA@cam.org> Dirk Mittler <mdirk@cam.org> writes:
>> >
>> >It isn't obvious that simple bacteria that have no cell walls really
>> >pose a health-hazard to humans. Our immune system easily destroys
>> >them.
>>
>>    Nonsense.  Some of them are just as hard to destroy as HIV, and for
>> the same reason-- they're inside *your* cells (ricketsia, Staph, TB)
>
>I don't intend to answer to every subject you have touched on - because
>I don't know them all. I intend to leave them written, though, and as
>true as the ones I know to be false. It's known from simple highschool
>knowledge that TB has cell walls. I haven't specifically heard that
>ricketsia and Staph don't.


   They do, but it's irrelevent for the reason I note below, and which
you quote, and seem not to have understood:


>> where the antibiotic doesn't pentrate.


   Got that?  Some antibiotics penetrate cells well, and some don't.
Staph ride around happily inside neutrophils, and that is one reason
they're hard to get rid of.  Penicillin doesn't get in there very well,
so that even Staph which are sensitive to penicillin (which almost all
were 60 years ago) are not killed.  An antibiotic like rifampin,
however, is concentrated by the white cell in the same place the Staph
hide, so it works well as an adjunct in deep-seated Staph infections.
However, it doesn't work on cell walls.

>>  On in an abscess which has the
>> same problem due to no circulation.  Or hiding in necrotic tissue.
>
>Well, an abscess consists mainly of immune system cells ("puss"),
>white for macrophages or yellow for granulocytes. Those don't kill the
>bacteria for some reason. They're alive and around the bacteria. Could
>you suggest why?


   Would I suggest why what?  The issue is that there are some places
antibiotics don't get to very well.  Even bacteria with cell walls are
not hurt by cell-wall active agents in these places.  So some other
kind of better penetrating agent is often needed.  Example already
given.


>> And as for cells with walls, there are all kinds of reasons for them to
>> be resistant to penicillin other than an enzyme that breaks it down.
>> They can have an enzyme that simply isn't inhibited by it. Or they can
>> have a transporter than doesn't pick it up to take it into the cell,
>> and is much more choosy about sugars. And so on. Evolution in action.
>
>Type in a phrase about "lactamase" on Alta Vista. Not only is the
>presence of lactamase known, but also that it isn't the product of one
>gene. Its occurrence in specifically those bacteria that were fought
>with antibiotics and are now resistant is shown to be induced. Has it
>ever occurred to you that the effect of one gene or a few can be
>systematic?

   Has it ever occured to you that you might not have a clue as to what
you're talking about?  Beta lactamases are responsible for only a tiny
fraction of total antibiotic resistance, and there are half a dozen
classes of antibiotics in general use which have nothing at all to do
with these enzymes, or with cells walls, or with anything you're going
on about.  Okay?  You go to medline and type in fluoroquinolone or
macrolide.  Consider how we deal with mycoplasma pneumonia.  Ponder the
mechanism of action of metronidazole.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: alt.support.sinusitis,sci.med,sci.pharmacy
Subject: Antibiotic Duration Rx (was Re: Beano with Antibiotic?)
Date: 15 Mar 1999 09:22:07 GMT

In <36EC9B91.4F7E7E78@servtech.com> Ed Mathes <emathes@servtech.com>
writes:

>> Do you think Augmentin should never be taken  longer than two weeks?
>>
>
>Only if appropriately prescribed.  Most bacterial infections will get
>better with a 'standard' 10-day course.



Comment:

    Maybe, and maybe not. I keep thinking of my ID attending who said
that the reason we give antibiotics for 7 to 10 days is because the
Hebrew God created the world in 7 days, and we have 10 fingers.  If our
prevailing myth had said 6 days and we had 12 fingers, that's what we'd
do.

     A better idea is possibly to give antibiotic for 48 hours until
all agreed upon relevent symptoms and signs are gone, up to some agreed
up maximum time.  But so long as things improve, yet there is continued
evidence of infection, the duration can be extended at will (or
contracted if things get better unsually quickly).  Three days of
Augmentin will cure many UTIs (indeed, even at the standard dose,
sometimes much less).  But it might take a month to cure a nasty case
of Staph foliculitis, osteomyelitis, or sinusitis (would want to add
rifampin in many of those cases).  And add time for diabetics, the
elderly, the malnurished, etc.   Stopping while the patient still has
certain signs of bacterial infection (notably fever, pus, erythema--
for osteomyelitis even more complicated tests) is a case of treating by
rote instead of treating the patient.

     Some of the problems here are social.  We've gotten very
puritanical about making people finish antibiotics, so as not to create
resistant bugs.  We give a 10 day supply of Augmentin to somebody with
a wound, and by the next day it's sealed, and by day five it no longer
is indurated or painful.  At 7 days they decide they're healed, and
quit.  Do we remonstrate?  Pace around and talk about how this kind of
behavior is causing the world to go to hell, and not following doctors'
orders (and the pharmacists' sticker on the label backing us up) in
this case is a sign of sloth, irresponsibility, and ignorance of
physiology?  It could happen.  But I'm hard pressed to think of any
really rational justification for it.  Had we actually (thinking of the
Hebrew god) *ordered* 7 days worth, and had done an office check that
day, we'd be patting ourselves on the back for having got the length of
the course correctly.  As if we can tell when a finger is red, swollen,
and hurts better than the patient can.  Duh-- this patient may have an
IQ larger than ours, and he certainly has nerve endings in his finger
we don't.

   The better answer is how long you should use antibiotics on
outpatients may be that it simply depends on what the disease is, and
how smart and reliable (not the same things) your patient is.  And
whether or not your feel that leaving somebody out there with a few
unused antibiotic pills is immoral.  What should you do with them,
these $3 Augmentin pills?  Flush them?  Save them in the refrigerator?
Bring them back to the doctor?  For the patient to have them, and not
need them, and not be able to return them, is for the doctor to tacitly
admit that he or she caused the patient to waste some money, and maybe
not a little money (let's talk about pediatric liquid formulas for
otitis media...).  Now THAT's the REAL reason behind some of what goes
on here in the world of "Takest Thou ALL thine medicine until it be
gone.  Or, Lo, The Sky Wilt Darken, and Drought Shall Be Upon the
Land.."  Let's just admit it, and get it over with.  It is sometimes
better, perhaps, to have written for 5 days, with 3 refills of 3 days.
But nobody does that.

   And with the pediatric suspention formulas, you CAN'T do that.  I
suspect this is Not Good.  A red eardrum is not an infected finger is
not a pneumonia.  In the case of the finger, your patient can tell when
the problem is gone as well as you can.  And in the case of pneumonia,
there's not a thing you can do in the office to tell when that first
antibiotic course should stop, that your patient can't do by using a
thermometer and considering how he feels.  In the case of otitis media,
your special ability to look in the ear doesn't help at all with the
decision to stop antibiotics.  That should have perhaps been our first
clue that the antibiotics weren't really doing any good for most of
those cases in the first place.

   I'm simply tossing out a few late night thoughts here. Comments
welcome.

                                      Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: alt.support.sinusitis,sci.med,sci.pharmacy
Subject: Re: Antibiotic Duration Rx (was Re: Beano with Antibiotic?)
Date: 16 Mar 1999 06:51:11 GMT

In <7ck48c$eku$1@news7.svr.pol.co.uk> "Mike Collins"
<mikeheatherc@oakwellmount.freeserve.co.uk> writes:

>A common problem that a lot of sinusitis sufferers have is the inability
>to distinguish between an infection and the inflammatory symptoms which
>follow an infection whether viral or bacterial in origin. For those of us
>who also have asthma, which perhaps started years before, we perhaps are
>more attuned to the early signs of infection. The sooner antibiotics are
>started the easier it is to treat the infection. Any delays due to
>misdiagnosis (?stress,? migraine,? ME etc) result in greater infection
>and prolonged inflammation. When I had my most severe infection I needed
>5 weeks Magnapen ( broad- spectrum penicillin) and only stopped when the
>pus became clear. Now when I get an infection I can get antibiotics
>immediately and a 2 week course is sufficient. I ususually experience
>relief after 3 days and yes a 5 day course would probably kill off ALL
>the bacteria but I am reluctant to stop for fear of acquired bacterial
>resistance.
>
>Heather Collins MLSO (Microbiology)



    Yes.  See another message where I toss out the idea of an empiric
trial of the two new leukotriene blockers Zafirlukast and Montelukast,
Zafirlukast probably being most likely to get into sinuses, since it's
more lipid soluable.

    And here's another wrinkle: it's a little-known fact (to the
orthodox doc, anyway) that antibiotics themselves are sometimes
anti-inflammatory, quite apart from their antibacterial action.  (The
alternative types are aware of this, and are always going on about how
antibiotics are immunosuppressive-- and they are correct about many of
them.  But what they miss is that immune suppression is not a bad thing
if inflammation is part of your problem.  They treat pediatric
meningitis with antibiotics AND steroids.  Sinusitis also).

   If you do a medline search you'll find that tetracyclines and
macrolides block some phases of neutrophil fuction in producing
inflammatory free radicals, and some penicillins and cephalosporins are
good direct free radical scavengers-- including those which neutrophils
make.   In Asia and Japan they quite deliberately use low-dose
erythromycin for its anti-inflammatory properties in chronic
bronchitis, long after it's understood that it can't be doing
anything bacteriologically.  In sinusitis, such an effect might well
help break the vicious cycle of inflammation, even after bacteria have
long since developed formal resistance to the drugs.  Many ENT docs
have long suspected that such drugs work in sinusitis and bronchitis
long after they should have lost all effect, but have filed this under
"mystery" and try not to think about it.  However, possible answers are
out there in the literature.

   Of all the antibiotics I know which have these effects, the ones
that are most penetrative into the CNS, and into abscesses and sinuses
and prostates (all difficult places to get at, with chronic
inflammation common), are minocycline, azithromycin, metronidazole,
trimethoprim, rifampin, and ceftriaxone and ceftazidime.  All but the
last two are available orally (and no, I don't know if Suprax is worth
using instead).

   For this use of these, remember that you're forgetting all you know
about bacteriology.  Just as you are when you treat Crohn's disease
with metronidazole.  Isn't it odd that this never seems to stop working
for those it does work for?  Hmmmm.  Makes you think,
eh?  Some of the very antibiotics mentioned above also keep working
topitally on acne, and do so for years, long after the skin flora are
resistant to them.  Indeed, drugs like metronidazole work on acne when
Propionibacteria and Staph aren't sensitive to it at all, ever.  So
what gives?  Well, now you know.  So do some thinking, and then do some
experimenting.  That which works on your skin ought to work anywhere it
can get to, where there's a problem.

                                         Steve Harris, M.D.

P.S.  Do be aware of the long term problems with some of these-- the
peripheral neuropathy of metronidazole and the pseudotumor cerebri of
minocycline.  Penetrative drugs can make you dizzy because they also
penetrate the inner ear.  Reading is required, and none of what I say
above is intended for the unwise.  Talk it over with your doctor and
study VERY carefully anything you plan to take for very long.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: alt.support.sinusitis,sci.med
Subject: Re: Antibiotic Duration Rx (was Re: Beano with Antibiotic?)
Date: 17 Mar 1999 08:03:52 GMT

In <g_wH2.68$mN.1929@news.cwix.com> "     MS"
<dontwrite@tothisaddress.com> writes:

>>So do some thinking, and then do some experimenting. That which works on
>>your skin ought to work anywhere it can get to, where there's a problem.
>
>Thanks again, Steve, for your long response.
>
>Well, it would be hard for me to "do some experimenting", as I'm not a
>doctor or pharmacist. I would have to convince a doctor to experiment.
>By the way, where do you practice?


   In Salt Lake City, a place where people who want to experiment and
try new things are repelled, and can't get to me.  When I want to
experiment myself, I have to go to California.

                                      Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: alt.support.sinusitis,sci.med
Subject: Re: Antibiotic Duration Rx (was Re: Beano with Antibiotic?)
Date: 18 Mar 1999 12:07:01 GMT

In <OWRH2.91$I01.1961@news.cwix.com> "     MS"
<dontwrite@tothisaddress.com> writes:

>>>By the way, where do you practice?
>>
>>
>>   In Salt Lake City, a place where people who want to experiment and
>>try new things are repelled, and can't get to me.  When I want to
>>experiment myself, I have to go to California.
>>
>>                                      Steve Harris, M.D.
>
>What do you mean by "people who want to experiment and try new things
>are repelled", and that you have to go to California to experiment
>yourself? As an MD, can't you choose what to prescribe for someone,
>regardless of what state you are in? So, do you practice in California
>also? (I live in that state.)
>
>Thanks,
>Mike



   I was being facetious.  Doctors are quite limited in what they can
do, due to state medical boards which have conservative licence views,
hopitals with even more conservative views on priveleges, a lot of
silly FDA laws, the malpractice and tort climate and the refusal of
society to let adults accept risk and responsibility for themselves,
and so on and so on.

    Utah's a more conservative state than just about any politically,
though in the area of private choice on medical matters they are
somewhat libertarian (most of the herb industry in the country is here,
and this is the seat of the most powerful self-treatment and
alternative treatment lobby).  The remark about going to California to
do research is an inside joke.  The private lab there where I do
medical research (animals, not people) happens to be there.  In many
ways California is tougher to do animal research in than Utah.

                                      S. Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: alt.support.sinusitis,sci.med,sci.pharmacy
Subject: Re: Antibiotic Duration Rx (was Re: Beano with Antibiotic?)
Date: 19 Mar 1999 20:59:38 GMT

In <7ctv5t$478$1@ligarius.ultra.net> wright@nospam.clam (David Wright)
writes:
>
>In article <7ckv0v$cl2@dfw-ixnews6.ix.netcom.com>,
>Steven B. Harris <sbharris@ix.netcom.com> wrote:
>
>>    And here's another wrinkle: it's a little-known fact (to the
>>orthodox doc, anyway) that antibiotics themselves are sometimes
>>anti-inflammatory, quite apart from their antibacterial action. (The
>>alternative types are aware of this, and are always going on about how
>>antibiotics are immunosuppressive-- and they are correct about many of
>>them. But what they miss is that immune suppression is not a bad thing
>>if inflammation is part of your problem. They treat pediatric meningitis
>>with antibiotics AND steroids. Sinusitis also).
>
>Steve, are these immunosuppressive effects ever permanent?  I see much
>wailing and gnashing of teeth on misc.health.alternative about how
>antibiotic use (long-term, anyway) does permanent damage to the immune
>system, carefully backed up by anecdotal evidence about how the
>writer, or the writer's grandmother's plumber's best friend, took
>antibiotics for a long time and then had all these health problems.


   No, this is an urban myth.  Your white cells turn over rapidly.  New
cells, new immune function.  Mostly, antibiotics affect neutrophil
function, and not all of them do.



>(I tried to research this one on medline but had no idea how to frame
>the query.)


   Try "neutrophil" "function" and "antibiotic".  Or you may have to
look at specific classes, such as "tetracycline" or "macrolide" or
"cephalosporin."

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: solumedrol/trovan
Date: 21 Mar 1999 10:38:31 GMT

In
<6225995F9DC30FFC.D3F99F0AFC3A4D9C.7EB9CA3D02EE973D@library-proxy.airne
s.net> jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox) writes:

>On Sat, 20 Mar 1999 08:39:27 GMT, "traceeglen"
><tbleakley@cyberback.com> wrote:
>
>>I was recently hospitalized for cystic fibrosis exacerbation, after
>>receiving iv doses of Trovan and Solumedrol I experienced creepy
>>hallucinations, (black & white images of spiders, snakes, et
>>al),dizziness, vomiting, and severe headache.  Which one of these
>>drugs is the most likely culprit?
>
>The Solu-Medrol would be my guess.  Corticosteroids can have creepy
>central nervous system effects.
>
>--
>Jonathan R. Fox, M.D.


    Trovan, also, though.  It gets into CNS much better than cipro, and
with IV doses we've all seen the difference in mental effects.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,alt.activism,talk.politics.medicine
Subject: Re: Backlash against HMOs: a declaration of war (was Doctor-bashing)
Date: 17 Apr 1999 11:39:36 GMT

In <37177763.9252EFF4@cs.uoregon.edu> Bret Wood
<bretwood@cs.uoregon.edu> writes:

>"Steven B. Harris" wrote:
>>
>>     That depends on a lot of things.  If antibiotics did not lead to
>> resistance, and if antibiotics were very cheap and free of side effect,
>> it would obviously be wise to take them whenever there was even a small
>> chance of an infection being bacterial, or being bacterial (which some
>> viral infections do-- they don't call one bacterial species "Hemophilus
>> influenzae" for nothing).
>
>Sure, but none of those "ifs" are true.  We can say "what if" for
>ever and it won't change reality.
>
>>     In the real world, the potential benefit to a particular patient of
>> treating a possibly bacterial infection is offset by harm to the
>> community in breeding resistant organisms.
>
>And you are ignoring the potential harm to the patient from side
>effects.  Even if the side effects are relatively minor, it's
>worse than no treatment if the illness is clearly not bacterial.



    But use of antibiotics for problems are "clearly not bacterial" is
not the problem, for rarely does this happen.  Most of the "problems"
with mis-use or mal-use of antibiotics are identified from
retrospectively considering the use of antibiotics in infections which
turned not to be bacterial (though this was certainly NOT "clear" at
the time), or else use of antitiobics for bacterial problems which they
don't help, or don't help much (many cases of acute otitis media,
otherwise healthy children, acute bronchitis in otherwise healthy young
adults, etc).  Or from use of an antibiotic which overbroad in coverage
(overkill) for the problem.   All of these pit the infectious disease
expert (sometimes with the benefit of hindsight, too) against the
family doctor who is working in real-time.  Not fair.  The
retrospectoscope always has 20-20 vision even when you're NOT an
expert.

  It was NOT obvious 10 years ago that antibiotics usually don't help
the average case of acute otitis media.  The large and clear studies
hadn't yet been done.



>Do you deny that antibiotic abuses by physicians has been a serious
>problem?

   I deny that it was a serious problem except in hindsight.  I suggest
only that those who wish to criticize have a crack at treating some ill
people in real time.  This is not a multi-choice test, and you don't
have the benefit of knowing what will happen.  You see the patient NOW,
and you treat NOW.   And if the patient winds up in septic shock in an
ICU somewhere in 2 days and you didn't give the antibiotic, you
remember that YOU get to explain it to the family and hostpital board
and the jury and so forth.

> Why do you skirt the issue by naming specific cases where
>it isn't a problem.  In general, a problem does exist.  (or at least
>it did exist in recent history)  Why can't you just concede a point
>instead of twisting words, and arguing on behalf of a well known
>case of widespread physician error.


   Because it's one of those well-known things which isn't so, in the
sense that there's an obvious solution.  Yes, there's a problem.  No,
it's not obvious what to do about it in any individual case.  It
doesn't help me the physician to know that even that MOST uses of
antibiotics in a given situation are inappropriate, unless you can
guarantee me that the patient in front of me is going to be one of
them.

From: sbharris@ix.netcom.com (Steven B. Harris)
Newsgroups: sci.physics,sci.med,talk.origins
Subject: Re: Atheism is Scientific?? [Re: A Question for the ALT crowd, ...
Date: 10 Jun 1999 20:34:46 -0400

In <7jp01v$i10@ds2.acs.ucalgary.ca> kmuldrew@acs.ucalgary.ca (Ken
Muldrew) writes:

>sbharris@ix.netcom.com (Steven B. Harris) wrote:
>
>>In <7jmf73$gkq@ds2.acs.ucalgary.ca> kmuldrew@acs.ucalgary.ca (Ken
>>Muldrew) writes:
>
>>>Sure, they could have, but there is no reason to suppose they did. We
>>>might just as well ask why the antibiotics evolved (not for
>>>antibacterial purposes, in most cases).
>
>>   No?  I would have supposed that was exactly why they evolved. Fungi
>>don't like competition for food.
>
>Conventional thinking is that most antibiotics are simply non-toxic
>(to the host organism) waste products. There are often cases where the
>class of microbe affected by an antibiotic cannot live in the same
>environment as the fungus that produces the antibiotic (due to reasons
>other than the presence of the antibiotic).



   I remain skeptical.  Some of these things (or all of them) doubtless
arose as metabolites (intermediates) in some other process, and were
found to be so useful that the organism started excreting them rather
than going the rest of the way to breakdown.  However, the idea that
some of these things themselves started out as end waste products is
pretty far fetched.  Tetracycline and erythromycin are pretty darned
complicated structures to be waste products.  Take a look at them again
if you haven't recently.  It takes energy to build things that
complicated and that relatively unsaturated out of simpler foodstuffs
like carbohydrate sugars.  If some Streptomyces are doing that and
excreting the energy laden product as "waste", they are the Wrong-way
Corrigans of the microbial world.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Pneumonia reoccuring
Date: 14 Jun 1999 09:38:30 GMT

In <3764A3B6.64BD83B6@cs.uoregon.edu> Bret Wood
<bretwood@cs.uoregon.edu> writes:

>I was really curious.  I didn't know that antifungals are considered
>antibiotics.  And I don't have any clue about the potential synergistic
>relationships between fungi and bacteria.  I have also heard that
>antibiotics can make some fungal infections worse.  So, it really was
>less than clear.


   Antibiotic did once refer very specifically to an antibacterial
substance found in nature.  Just as electrocution once referred only to
somebody subjected to electrical execution.  The problem was that other
substances have been found in nature that inhibit fungi, and even
viruses.  And there are man-made ones, also.  We needed the word.  We
can be technical and say "antimicrobial," (or antiviral, antifungal,
and say "synthetic antibiotic"), or we can be sloppy.  And refer to the
guy who dies with the knife in his toaster as being electrocuted, too.
That's how language works.

   Antibacterials are generally only bad for candida, which seems to be
very much inhibited by normal skin and vaginal bacterial flora.  Their
effect on athelete's foot is marginal.  That fungus is way too deep in
most people to be influenced by skin bacteria (so deep that the only
really effective treatment for many is an oral antifungal, like
Diflucan).  Though I would not be surprised if being newly on
antibacterials didn't lower your resistance to getting athelete's foot
newly.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.pharmacy
Subject: Re: Antibiotics -- when is "overuse" ?
Date: 1 Jan 2000 13:01:09 GMT

In <386DDA83.568A@excite.com> "Troy D." <caGe88@excite.com> writes:

>First, my apologies if this is not the appropriate newsgroup for this post.
>Second, I'll try to be as coherent as possible.
>: )
>
>
>I am a 35 yr. old caucasian male who comes down with upper respiratory
>infections about 3 - 5 times a yr.  I don't smoke, am not overweight,
>and have no other pathological/physiological agents working against me
>(that I know of, to this point).  I feel that this is too often to be
>getting sick.
>
>
>My GP has been very good at evaluating the infections, as the various
>antibiotics he prescribes *always* do the trick, often bringing noticable
>relief in the first day.  And, he does not feel that this frequency of
>infection is cause for concern.  Full-panel blood tests show nothing
>abnormal, I even tested negative for HIV.
>
>
>So, my hope is for comments on the following:
>
>1.  Is this indeed a common rate of URI ?
>2.  If so, should I be concerned about overuse of a/b's ?  (Indeed, is my
>    state a *result* of said overuse?)
>
>
>Thank you in advance,
>Troy Dillon, USA




   No good answers.  If you use the same antibiotic every time, it's
not likely you'll have many problems, since your bugs will still be
sensitive to pleny of others, and your own flora will adapt.

   So why does the same antibiotic seem to work on some people, every
time?  Indeed, why do antibiotics on the skin treat acne sucessfully,
sometimes for years?  Surely the complex flora of the gut and skin (not
to mention chronically infected sinuses or bronchi) adapt completely,
in that time?

   Probably they do.  Alas, some antibiotics have anti-inflamatory and
immunomodulatory activity, and probably aren't working as antibiotics
at all, for some people that they help.  Including many used topically
for acne, surprise.  Erythromycin, tetracyclines, and metronidazole are
well known for this kind of thing in the literature, but possibly not
to your doctor.  Erythromycin is used as an upper respiratory tract
antiinflammatory, especially good for sinus, allergy, and chronic
bronchitis problems, in Japan and a few other places.  The idea hasn't
caught on here in the US, except by accident.  And it's only comes up
as a point to ponder, when people wonder why in the world some
"antibiotic" keeps working the way it does, on themselves or their
kids.  The answer is that they may be doing the right thing for the
wrong reason, while all the while society is trying to get them to
start doing the wrong thing, for what seem good and right reasons.

  What we really need to be doing is looking for some antibiotic
derivatives which have no antibiotic activity at all.  I wish some
pharm company would start a serious investigation of all their "failed"
antibiotic derivatives in this fashion.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Antibiotics -- when is "overuse" ?
Date: 4 Jan 2000 09:34:14 GMT

In <3871E46C.48CA@idt.net> "John G." <guz@idt.net> writes:

>What I could never get a good answer on was: why is one
>told not to consume alcoholic beverages while on a/b's ?


Only true for one antibiotic: metronidazole/Flagyl.  It has an Antibuse
effect, and apparently somehow inhibits alcohol metabolism.

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: misc.kids.health,sci.med
Subject: Re: Death From Ritalin
Message-ID: <xdGq9.34516$lV3.2718667@newsread1.prod.itd.earthlink.net>
Date: Mon, 14 Oct 2002 20:58:05 GMT

Matti Narkia wrote in message ...
>Sun, 13 Oct 2002 16:15:23 -0700 in article
><bqucoa.0pl.ln@news.lumbercartel.com> "D. C. Sessions"
><dcs@lumbercartel.com> wrote:
>>
>>Since the first vaccine predates the first pharmaceutical
>>corporation, it stands to reason that it wasn't developed
>>by one.
>
>Exactly.
>
>>The first antibiotic, on the other hand, may well have been
>>discovered by someone working for a pharmaceutical company:
>>Sulfonamide was discovered in 1932 to be effective against
>>bacteria by Gerhard Domagk, working for Bayer.
>
>Incorrect. He worked for IG Farbenindustrie, see
>
>Gerhard Domagk ) Biography
>http://www.nobel.se/medicine/laureates/1939/domagk-bio.html
>
>and
>
>IG Farbenindustrie AG
>http://www.us-israel.org/jsource/Holocaust/farben.html
>
>>  At about
>>the same time, May and Baker produced sulfadiazine (known
>>as "M and B.")  Whether these were the first *discovered*
>>is unclear, since Fleming made his first observations on
>>penicillin in 1927 or 1928, but they certainly were ahead
>>in terms of clinical use.
>>
>I see nothing unclear in this. In my number system 1928 comes before 1932.
>
>>Therefore, pretty much however you slice it, you're wrong
>>that "neither antibiotics nor vaccines were invented by
>>pharmaceutical companies."
>
>Not so, see above.
>
>
>
>--
>Matti Narkia


Comment:

In 1932, Gerhard Domagk, working in the animal research institute (Igefa in
Elbersfeld) at I.G. Farben reported that prontosil (a textile dye
synthesized in 1908) was active against bacterial infections in mice. Domagk
got the Nobel prize, and deserved it. His check was paid for by a chemical
company doing bona-fide pharaceutical research, so it was certainly
pharmaceutical corporate research. It would be rather legalistic of you to
weasel out by claiming that IG Farben wasn't a pharmaceutical company. It
was a monster company into all kinds of things, like Dow and ADM today. Any
company that has a pharmaceutical development division counts as a
pharmaceutical company.

Matti, there's no point in "inventing" or discovering something that is so
difficult to make, that it isn't available to more than a couple of people.
Fleming may have reported in 1929, before 1932, that there was something
made by mold that killed bacteria in a petri dish, but the development of
penicillin into a product that was available to people who needed it, was
due to other people, and didn't come until much later. Fleming didn't even
discover that penicillin was a useful antibiotic in vivo-- that was Florey
and Chain in 1940 who first showed that penicillin killed bacteria in mice,
then people, following the example of Domagk. It took a huge amount of
commercial development to get penicillin into the market, during WW II.

A similar thing happened with insulin and commercial development. Three
Canadians discovered a stuff in pancreas that could lower the blood sugar in
dogs, but they never saved any lives with it. It was too impure and too hard
to make. Lives only started being saved when the Lilly Co. figured out how
to extract and market the pure stuff in bulk.  Again you can't save lives
without this two-stop process, and it's not a medical breakthrough, until
you start to save a lot of lives. Till then, it's merely a scientific
breakthrough, of interest to gray old men reading journals in libraries, but
of no impact on the man in the street.

SBH

--
I welcome email from any being clever enough to fix my address. It's open
book.  A prize to the first spambot that passes my Turing test.