Couple of questions for prescribing docs (or anyone else ftm) incoming…
I’m doing a research poster on a topic of my choice related to medicine and the environmental impact, and would like to use tetracycline since it is used often and readily by many. When I did my initial Google and Chem library look-up, I get several sites aimed at haz mat folks but none that narrow the research.
Is there a site that describes proper disposal of unused medicines, where I could research tetra?
I’m hoping to find a few that address the affect of excreted pharmaceuticals on the environment, an alternative prescription available that is more “green”, and more generally, how tetra works? Does it kill the bacteria and then exit the system partially intact with dead bacteria as well?
Thank you!
The only infor that I found specifically for tetracycline is in regards to agrigcultural use and ground water run offs. I did find these sites if it helps any:
http://www.pfizer.com/files/Pfizer_PIE_Over view.pd…
http://www.dtsc.ca.gov/AssessingRisk/PPCP/in dex.cf…
http://www.gsk.com/responsibility/cr_iss ues/ehs_mf…
http://www.campusecology.wsu.edu/m_roth_review_of_…
http://www.ijc.org/rel/pdf/09_Pharma-fal l2002.pdf
http://www.fda.gov/consumer/updates/drug _disposal0…
Try the NIEHS website,.
Hey I just prescribe it, what happens to it after that is not my problem 
…
All joking aside, I had a vague memory that tetracycline’s mechanism of action makes it “bacteriostatic,” meaning it inhibits bacterial growth rather than “bactericidal,” meaning that it kills the organism. I googled “tetracycline bacteriostatic” and found that I was right. I also found a Wikipedia entry for tetracycline that explains its mechanism of action.
Obviously Wikipedia is not a primary source but I have to confess that I use it a lot as a way to help me direct my searches for information. Dr. Google is almost always my first consult. In this case, search for "tetracycline [something about biodegradation? mechanism of action? you pick] and I’ll bet you’ll find some stuff.
BTW can’t remember the last time I prescribed tetracycline. Antibiotics I prescribed last week (many of them probably completely unnecessary): amoxicillin, amoxicillin/clavulanate (Augmentin), cefdinir, ciprofloxacin, levofloxacin, azithromycin, trimethoprim/sulfamethoxa zole (Bactrim), doxycycline (which is a relative of tetracycline).
I like to hope that at least some of 'em did some good.
Mary
Thank you, Mary!
Is there a reason you prescribe Amoxi vs. peni? Is there is differential in absorption or bacterial kill rate? Better tolerated by people?
We changed our topic from tetra to peni… apparently, it’s a smaller molecule to work with but that remains to be seen.
If someone is allergic to peni and the derivatives, is there something else you would go to? Or would you kick good ole Z-maxx? I’m thinking if there is something that would get prescribed in place of peni, it’d be good research to have that as part of presentation materials (that we did do our own drug of choice but then in follow-up research found that subsequent medication does x-y-z).
Wiki… haha. Was specifically mentioned as not being usable. My only other question is how far back can we go (TA ?? already asked).
I also was pointed to ISI Web of Knowledge for cited peer materials.
Thanks again!
- jkp2117 Said:
Is there a reason you prescribe Amoxi vs. peni? Is there is differential in absorption or bacterial kill rate? Better tolerated by people?
Amoxicillin can be taken twice a day and still be effective.... penicillin *can* be prescribed as twice-a-day dosing but is a little less effective that way. Here in the trenches we are not concerned about kill rates! I want a medication that is cheap and that people will actually take until they're done. The fewer times a day they have to take it, the more likely they'll be able to. *I* can't manage to remember to take medication twice a day, so I am painfully aware that prescribing something with three- or four-times daily dosing is just asking for treatment failure.
- In reply to:
Depends on the PCN allergy. There's some cross-reactivity between PCN and cephalosporins but many pen-allergic people can take cephalexin, cefdinir, or one of the other "cefs." Azithromycin is not as good. There is a pocket guide, the "Sanford Guide," that is my treatment bible. It categorizes all infectious inflictions and gives you latest recommendations on treatment choices. It says that 35% or more of group A beta-hemolytic strep is resistant to azithromycin. It also says penicillin is the drug of choice for strep but I choose to ignore it.
There is an online version of the Sanford guide but I think it is subscription. G'luck!
Thank you, Mary!! Appreciate the extra info and guidance to Sanford.
Cheers!
Thanks Mary that’s so interesting! I’m starting to become intrigued by medications and their effects. It’s quite fascinating. The penicillan/amoxicillan information was great to read being I have a kid with those allergies.
A little reminder to all of us though…read patient information before prescribing! I can’t tell you the number of times I’ve had doctors try to prescribe something I or someone I know was allergic to in spite of it being in bright red/orange on their charts. The recent one was my little one had an infection (I can’t recall if it was strep or just otis media) and the ped we saw noticed the prior ped had prescribed Omnicef the last time she needed meds. He kept trying to point out that he doesn’t like prescribing it but prefers amoxicillan (not sure why) until I interjected and said “well, that’s fine and all, but if you’d look up and to the right hand corner of your computer screen you’d notice she’s allergic to that.” The result? We went home with omnicef again haha. He seemed a tad embarassed, and I hated doing it to him, but I’d rather not risk a reaction.
I assume these little oversights are due to the sheer magnitude of patients seen a day. It has to get confusing after a while.
- BOOBS Said:
Yep, that is putting it mildly!
Now, there is something called "amoxicillin rash" which is NOT an allergy, rather a weird reaction, and all the literature exhorts us to try again with amoxicillin because chances are the kid won't get the same reaction twice. I haven't met any provider yet who's willing to give it a try - the rash is impressive and alarming. We all enter "allergic to amoxicillin" in the chart. Much as I'd like to spend more time explaining stuff to people, that's what keeps me running behind as it is......
And I have cheerily given my own kid cephalosporins despite her **wheezing** reaction to a 'cillin (uneventfully, whew!) -- something that I won't do when prescribing for someone I'm not related to haha.
Mary