If you had to pick one antibiotic...

[Liff]

First off, I rate this thread as good. Among people who deal with antibacterials or antibiotics as part of their normal job there is consensus that there is not a "The One" antibiotic, and no one should be looking for something like that. Anytime a good question is asked and there is that much consensus, it clearly represents the current thought in the state of whatever topic is being discussed.

There are good romper stomper combinations that fail in a different infection, and the better point is that the reverse is also true. And we have not even started to discuss why an E Coli infection of the prostate needs cipro for 28 days while the same E Coli bacteria causing a UTI needs therapy for 3 days. (Guidelines vary.) Or how different areas in this country have different rates of antibacterial resistance. What works well in Texas may be a poor choice in North Dakota.

Lots and lots goes into this topic. A little knowledge can be (not "is", but "can be") a dangerous thing.

Either way, stock up of fish antibiotics. (Just in case: blue text means sarcasm on this board.)

[Vicarious_Lee]

First off, I rate this thread as good. Among people who deal with antibacterials or antibiotics as part of their normal job there is consensus that there is not a "The One" antibiotic, and no one should be looking for something like that. Anytime a good question is asked and there is that much consensus, it clearly represents the current thought in the state of whatever topic is being discussed.

There are good romper stomper combinations that fail in a different infection, and the better point is that the reverse is also true. And we have not even started to discuss why an E Coli infection of the prostate needs cipro for 28 days while the same E Coli bacteria causing a UTI needs therapy for 3 days. (Guidelines vary.) Or how different areas in this country have different rates of antibacterial resistance. What works well in Texas may be a poor choice in North Dakota.

Lots and lots goes into this topic. A little knowledge can be (not "is", but "can be") a dangerous thing.

Either way, stock up of fish antibiotics. (Just in case: blue text means sarcasm on this board.)

All true. Also true: In a PAW I would suck dick for Vanc and Zosyn.

[Tperkins]

I'd probably be split between Levofloxacin (or maybe Cipro) or Azithromycin. I often have problems with allergies, where Azitrhomycin would be good for a URTI or LRTI without some of the risks of Levofloaxin/Ciprofloxacin. Levo/Cipro do, however, have the upsides of being stronger as well as working on skin infections as well. While the chances are rare, it is worth considering that Levofloxacin an Ciprofloxacin work well in the treatment of Anthrax, should you somehow be knowingly infected with it an a SHTF scenario where the correct medical care would not be available. Both are also effective agaisnt Yersinia pestis, which is the enterobacteria that causes all three types of plauge. While that may not be an issue now, post-SHTF it could again become a problem.

However, to second what many above said, proper HYGEINE and proper water/food purification/cooking will near eliminate the need to take antibiotics, sans the accidental cut or excetera. Use soap or antiseptics like betadine, and (YMMV) stay away from antibacterial soaps, or at least a regular usage of them. Antibacterial soaps can, for the same reason as antibiotics, create resistant bacteria. So you have a soap that kills 99% of bacteria; thats great right? Wrong, now you have that 1% of bacteria to grow uninhibited by the other organisims that were preventing it's rapid growth. If it's nonpathogenic, no big deal, but if it is something that can cause an infection, you've just given it the boost it may have needed to do so. Again, that's my opinion through my research; the FDA is reviewing that issue (with Triclosan) so you can wait for their results if you so wish.

But anyway, what was said before me by some of you guys, you had it dead on.

Edit: Liff, out of curioisity, why the sarcasm on the fish antibiotics? Their use is not contraindicated as long as you know what you're doing, or are you assuming their use by the general and uneducated (pharmaceutically, no insults intended) public?

[Liff]

Edit: Liff, out of curioisity, why the sarcasm on the fish antibiotics? Their use is not contraindicated as long as you know what you're doing, or are you assuming their use by the general and uneducated (pharmaceutically, no insults intended) public?

Two reasons. The first is that while the use antibiotics is not contraindicated, it is also not indicated. We all know it is probably the same everything that is sold indicated for human use, but fish antibiotics are not indicated for human use.

The second is that the people who advocate fish antibiotics, especially storing them for the paw, do not have a water filter, soap, any idea how antibacterials work in the first place, any idea as to how long or how much to take, have no idea that about half of all ER admits for adverse drug reactions are due to antibacterials, and they generally think the PDR is a great reference source. I don't care if they hurt themselves, but it is a different story when one person's actions hurt another person.

Antibiotics are not the be all end all that people think they are. Here is a good link, 80,000 Chinese die from using antibiotics every single year. Not die from the infection, but die from using the antibiotics.

YMMV and all, but don't let your preps hurt or kill you.

[Scout308]

OK - my knowledge in this area is ZERO, Zip, Nada, Jack, Squat, Non-existant - I am Sans Clue

I have no known allergies (ok - maybe a slight reaction to Belladonna, and I hate peas)
Area - Pacific North WET
Assume no readily available medical expertise (I have Ancient EMT training - like 1974. I'll probably try to get that updated, as EVERYTHING has changed since then) My group has no doctors/nurses/paramedics/......

Let's start with the basics - Of Liff's list - I have those covered (x3)
So I'm looking for Recommendation for the following

1. Topical - I have Polysporin and Neosporin which both work very well for me, and betadine (not enough), I'm open to suggestions for alternates/replacements.

2. Oral - I guess the first thing is to figure out how to tell if one is needed (I dislike the approach of throwing antibiotics at everything - just in case).
Are there any Just do it - conditions (e.g. Stab wound, GSW, some idiot decided to drink out of the pond unfiltered....)

3. Baring those, can you learn enough from a book to make a reasonable guess as to usage? (if so What books?)

Assuming there is some way for a layman to determine to a reasonable degree that an oral antibiotic might be effective and which one (ignoring unknown allergic reactions):

4. Are there any antibiotics that I can get with out a script (veterinary, etc) that I should even consider?

5. Assuming I can get a script - which two/three should I be looking at - and how long will they survive at an average temp of less than 55degrees

[Jamie]

I get antibiotics for my fish from cal-vet:

http://www.calvetsupply.com/category/Oral_Antibiotics/a

Jamie


Sent from my iPad by the power of Greyskull!

[Tperkins]

Edit: Liff, out of curioisity, why the sarcasm on the fish antibiotics? Their use is not contraindicated as long as you know what you're doing, or are you assuming their use by the general and uneducated (pharmaceutically, no insults intended) public?

Two reasons. The first is that while the use antibiotics is not contraindicated, it is also not indicated. We all know it is probably the same everything that is sold indicated for human use, but fish antibiotics are not indicated for human use.

The second is that the people who advocate fish antibiotics, especially storing them for the paw, do not have a water filter, soap, any idea how antibacterials work in the first place, any idea as to how long or how much to take, have no idea that about half of all ER admits for adverse drug reactions are due to antibacterials, and they generally think the PDR is a great reference source. I don't care if they hurt themselves, but it is a different story when one person's actions hurt another person.

Antibiotics are not the be all end all that people think they are. Here is a good link, 80,000 Chinese die from using antibiotics every single year. Not die from the infection, but die from using the antibiotics.

YMMV and all, but don't let your preps hurt or kill you.

Definetley agree with the above; I'd never advocate their use unless you had a good working knowledge of what you are doing, or have someone (family/friend) who would be able to tell you what dosages you need, at what times, and for how long. While PDR is a great reference, as any reference, it's no substitute to training at all. Antibiotics are a nessessary evil; it's obvious how their overuse and misuse have contributed to the resistance in certain areas, along with the appearance of resistant strains such as MRSA. Now, I wont argue but from research I have done (dozens of hours) on assorted pharmaceuticals, there are certain drugs that I stock in sufficent quantities to allow a few uses for misc. infections, but I would not use without being advised from either my family friend physician (who knows my plans to some extent, and understands my concern) or the couple physicians I know personally, who I could at least describe signs and symptoms to them, and maybe they can give advice. Post-SHTF of course though, otherwise I always see my physician, even though that's usually only once or twice a year tops. I've also only taken antibiotics about once or twice every few (2-3) years for most of my life, so I'm not too worried about loosing effectiveness or restistance.

Now, if it's the PAW, and I'm oozing pus from a cut to my forarm that's become obviously infected, would I take a fish store antibiotic? Bet your ass I would, because I know enough to ascertain that it's an infection. Would I take an antibiotic as soon as I got cut in the PAW, absoloutley not, and I think that's what needs to be stressed. It's an absolute last resort. It's not advocated as a precautionary measure, that's what betadine is for. I guess a good way to sum the argument for/agaisnt taking it, ecterea, is that if you need to ask what kind of antibiotic at what dose you need, you shouldn't be self-administering it. I'd prefer not to ever have to attempt to administer antibiotics to myself without advice from a physician, but if I needed too, I at least have a general idea of what I'm doing. I occasionally get URTI's and LRTI's, and it's always the same treatment: Azithromycin, 500mg/day PO. So, as a URTI at least is pretty obvious (while it can be bacterial), I would feel fairly comfortable dosing myself as it's always the same issue, signs/symptoms, ect. But anyway, I digress as I'm rambling on it seems.

[PotatoMuncher]

Z-Pack, straight up. Very commonly used, very easy for even the most average Joe to follow, and it's a good almost-cure-all.

[dallas]

I would like to throw out the one thing I see missing in most answers here. There is no "stronger"antibiotic. All antibiotics have shortcomings.

Cipro, Levofloxacin or Azithromycin may be great for somethings, but they will not touch MRSA most of the time. In a lot of places MRSA is very common in the community. For skin infections here, most of the time bactrim works great. It is our drug of choice. No need to even use clindo.

You have to match your antibiotic to the structure infected and the probable bacteria, fungus or protozoan causing the infection.
For example how would you treat this?

http://upload.wikimedia.org/wikipedia/commons/7/7a/Sporotrichosis_by_the_fungus_Sporothrix_schenckii_PHIL_3940_lores.jpg

That is a fungus, you can make things worse with an antibiotic. Which antifungal for how long?

However, atypical mycobacterium looks similar. Then you need an antibiotic. Which one for how long?
http://ftguonline.org/files/images/FTGU_2_2_04_img_31.jpg

Antibiotics are a complicated subject. There is no easy answer.

[dallas]

Z-Pack, straight up. Very commonly used, very easy for even the most average Joe to follow, and it's a good almost-cure-all.

They only appear to be an "almost cure all" because they are over prescribed. Most of the time you will get better just as fast with nothing.

The over use of antibiotics is causing a big problem. The bugs are going to win unless we change how we do things. It is no fun treating a multi-drug resistant case.

[duodecima]

Z-Pack, straight up. Very commonly used, very easy for even the most average Joe to follow, and it's a good almost-cure-all.

Until, since the PAW is unlikely to happen tommorrow, it gets so overused that the resistance rates go up. I get more requests for this antibiotic than any other, from people who just know that their personal respiratory infection really needs it. Because "I've had so much amoxicillin I'm immune to it now." Maybe everybody else has a virus, but no, they need azithromycin. Levaquin used to have really low resistance rates too, no longer the case... I am equally if not more frustrated with my colleagues who collude in this practice, rather than pissing off an admittedly ill and uncomfortable patient by explaining them that an antibiotic won't help...

It doesn't work for most urinary or abdominal infections, btw. Far from first choice for wound/skin, as well.

[/rant]
Azithro is still a very nice drug, it's still probably my #2 prescribed antibiotic, when antibiotics are indicated. Good choice for many things respiratory.

Antibiotic misuse and overuse, by professionals and patients, is a personal pet peeve of mine. (in case you hadn't noticed. ) (fake edit : waves hello to dallas)

Also, I'm not blowing anyone for vanc or zosyn unless I've also got sterile IV stuff available.

[PotatoMuncher]

Z-Pack, straight up. Very commonly used, very easy for even the most average Joe to follow, and it's a good almost-cure-all.

Until, since the PAW is unlikely to happen tommorrow, it gets so overused that the resistance rates go up. I get more requests for this antibiotic than any other, from people who just know that their personal respiratory infection really needs it. Because "I've had so much amoxicillin I'm immune to it now." Maybe everybody else has a virus, but no, they need azithromycin. Levaquin used to have really low resistance rates too, no longer the case... I am equally if not more frustrated with my colleagues who collude in this practice, rather than pissing off an admittedly ill and uncomfortable patient by explaining them that an antibiotic won't help...

It doesn't work for most urinary or abdominal infections, btw. Far from first choice for wound/skin, as well.

[/rant]
Azithro is still a very nice drug, it's still probably my #2 prescribed antibiotic, when antibiotics are indicated. Good choice for many things respiratory.

Antibiotic misuse and overuse, by professionals and patients, is a personal pet peeve of mine. (in case you hadn't noticed. ) (fake edit : waves hello to dallas)

Also, I'm not blowing anyone for vanc or zosyn unless I've also got sterile IV stuff available.

To be completely honest, the main reason I choose Azithro is because I have asthma, and I use Advair which can increase chances of developing an URI. That, and living down here in Louisiana can really jack up your respiratory system. Still my favorite antibiotic I handed out overseas.

Second would be Cipro. Ive become more and more interested in it as of late. I really only got my hands on it once or twice while in the aid-station, but I never truly got to read up on it.

[dallas]

Z-Pack, straight up. Very commonly used, very easy for even the most average Joe to follow, and it's a good almost-cure-all.

Until, since the PAW is unlikely to happen tommorrow, it gets so overused that the resistance rates go up. I get more requests for this antibiotic than any other, from people who just know that their personal respiratory infection really needs it. Because "I've had so much amoxicillin I'm immune to it now." Maybe everybody else has a virus, but no, they need azithromycin. Levaquin used to have really low resistance rates too, no longer the case... I am equally if not more frustrated with my colleagues who collude in this practice, rather than pissing off an admittedly ill and uncomfortable patient by explaining them that an antibiotic won't help...

It doesn't work for most urinary or abdominal infections, btw. Far from first choice for wound/skin, as well.

[/rant]
Azithro is still a very nice drug, it's still probably my #2 prescribed antibiotic, when antibiotics are indicated. Good choice for many things respiratory.

Antibiotic misuse and overuse, by professionals and patients, is a personal pet peeve of mine. (in case you hadn't noticed. ) (fake edit : waves hello to dallas)

Also, I'm not blowing anyone for vanc or zosyn unless I've also got sterile IV stuff available.

Hello,(wave back) and thanks for the backup. Some of my colleagues prescribing habits make me pull my hair out too.

I see too many patients with normal bacteria confirmed with a culture and sensitivity who go to another doc for a ton of antibiotics for every little complaint. They then come back a year later with bugs resistant to nearly everything when I do a culture and sensitivity. I see this all the time.

[dallas]

I just found this and skimmed through it quickly. It seems like a good introduction to antibiotics.

http://medtextfree.wordpress.com/2010/0 ... l-therapy/

[SRO1911]

My meds are about my most successful prep. Aside from enough Imitrex to drown a bus load of zeds I have managed to stock up on the best anti-biotics for me. With a massively deviated septum I get a lot of sinus infections and have a very good dr. - I have "several" vials of rocephin, along with the requisite lidocain and saline solution to reconstitute. As well as the proper accompaniment of prednisone.
Knowing how bad that shit HURTS going in, there is not much risk of abuse.
I have proper dosages for every one in my family charted in the med bag - if you are not part of my planned group you are SOL.

[duodecima]

- I have "several" vials of rocephin, along with the requisite lidocain and saline solution to reconstitute. As well as the proper accompaniment of prednisone.
Knowing how bad that shit HURTS going in, there is not much risk of abuse.

The big problem with antibiotic misuse is that, it's not done recreationally, or willfully - it's done in the completely sincere albeit incorrect belief that the provider and/or patient are doing the right and appropriate thing to get better. nobody abuses antibiotics like they're narcotics or anything.

I realize most folks here a prepping for a PAW and not planning to use this stuff until then, unless their provider tells them to do so. Some folks, as above, have specific knowledge and direction about when to use things for their situation.

But that's another reason why the whole fish antibiotics thing, or the idea that any antibiotic could be anything remotely like a 'cure-all' makes a some of us grind the enamel off our teeth.

[dallas]

My meds are about my most successful prep. Aside from enough Imitrex to drown a bus load of zeds I have managed to stock up on the best anti-biotics for me. With a massively deviated septum I get a lot of sinus infections and have a very good dr. - I have "several" vials of rocephin, along with the requisite lidocain and saline solution to reconstitute. As well as the proper accompaniment of prednisone.
Knowing how bad that shit HURTS going in, there is not much risk of abuse.
I have proper dosages for every one in my family charted in the med bag - if you are not part of my planned group you are SOL.

You are kiding about the rochephin for a sinus infection right?


http://www.idsociety.org/2012_Rhinosinu ... uidelines/

"Nearly one in seven people suffer from sinus infections every year, but 90 to 98 percent are caused by viruses."

The IDSA rhinosinusitis guidelines contain a number of other recommendations, including:

How to tell the difference – The guidelines note a sinus infection is likely caused by bacteria and should be treated promptly with antibiotics if: symptoms last for 10 days or more and are not improving (previous guidelines suggested waiting seven days); or symptoms are severe, including fever of 102 or higher, nasal discharge and facial pain lasting 3-4 days in a row; or symptoms get worse, with new fever, headache or increased nasal discharge, typically after a viral upper respiratory infection that lasted five or six days and initially seemed to improve.

Shorter treatment time – Most guidelines to date have recommended 10 days to two weeks of antibiotic treatment for a bacterial infection. However, the IDSA guidelines suggest five to seven days of antibiotics is long enough to treat a bacterial infection without encouraging resistance. The IDSA guidelines still do recommend children receive antibiotic treatment for 10 days to two weeks.

Avoid decongestants and antihistamines – Whether the sinus infection is bacterial or viral, decongestant and antihistamines are not helpful and may make symptoms worse. Nasal steroids can help ease symptoms in people who have sinus infections and a history of allergies.

Saline irrigation may help – The guidelines note nasal irrigation using a sterile solution – including sprays, drops or liquid – may help relieve some symptoms. However, the guidelines note this may not be helpful in children because they are less likely to tolerate the discomfort of the therapy.

[dallas]

- I have "several" vials of rocephin, along with the requisite lidocain and saline solution to reconstitute. As well as the proper accompaniment of prednisone.
Knowing how bad that shit HURTS going in, there is not much risk of abuse.

The big problem with antibiotic misuse is that, it's not done recreationally, or willfully - it's done in the completely sincere albeit incorrect belief that the provider and/or patient are doing the right and appropriate thing to get better. nobody abuses antibiotics like they're narcotics or anything.

I realize most folks here a prepping for a PAW and not planning to use this stuff until then, unless their provider tells them to do so. Some folks, as above, have specific knowledge and direction about when to use things for their situation.

But that's another reason why the whole fish antibiotics thing, or the idea that any antibiotic could be anything remotely like a 'cure-all' makes a some of us grind the enamel off our teeth.

I think I just cracked a molar.

[dallas]

If you really must have a course on what antibiotic to use in a EOTWAWKI situation, this is the best for trauma. This is for entertainment purposes only. Do not try this at home.

http://www.idsociety.org/uploadedFiles/ ... Trauma.pdf

They have some other good guidelines too.

Like:
http://www.idsociety.org/Topic_Antimicr ... esistance/

[Tperkins]

- I have "several" vials of rocephin, along with the requisite lidocain and saline solution to reconstitute. As well as the proper accompaniment of prednisone.
Knowing how bad that shit HURTS going in, there is not much risk of abuse.

The big problem with antibiotic misuse is that, it's not done recreationally, or willfully - it's done in the completely sincere albeit incorrect belief that the provider and/or patient are doing the right and appropriate thing to get better. nobody abuses antibiotics like they're narcotics or anything.

I realize most folks here a prepping for a PAW and not planning to use this stuff until then, unless their provider tells them to do so. Some folks, as above, have specific knowledge and direction about when to use things for their situation.

But that's another reason why the whole fish antibiotics thing, or the idea that any antibiotic could be anything remotely like a 'cure-all' makes a some of us grind the enamel off our teeth.

I think I just cracked a molar.

Wouldn't want that to get infected; maybe take some antibiotics? Just kidding.

Anyway, on those IDSA guidelines, I agree with everything there except I'm suprised they say that antihistamines and decongestants are contraindicated for a sinus infection? While steriods can help, I've often seen/heard them contraindicated due to possible addiction. I've always taken 120mg of Pseudoephedrine for nasal congestion, and add Guaifenesin if I'm getting chest congestion; I've certainly noticed an improvement in both, certainly not a deterioration. YMMV I suppose? Just thought that was kind of odd.

[dallas]

- I have "several" vials of rocephin, along with the requisite lidocain and saline solution to reconstitute. As well as the proper accompaniment of prednisone.
Knowing how bad that shit HURTS going in, there is not much risk of abuse.

The big problem with antibiotic misuse is that, it's not done recreationally, or willfully - it's done in the completely sincere albeit incorrect belief that the provider and/or patient are doing the right and appropriate thing to get better. nobody abuses antibiotics like they're narcotics or anything.

I realize most folks here a prepping for a PAW and not planning to use this stuff until then, unless their provider tells them to do so. Some folks, as above, have specific knowledge and direction about when to use things for their situation.

But that's another reason why the whole fish antibiotics thing, or the idea that any antibiotic could be anything remotely like a 'cure-all' makes a some of us grind the enamel off our teeth.

I think I just cracked a molar.

Wouldn't want that to get infected; maybe take some antibiotics? Just kidding.

Anyway, on those IDSA guidelines, I agree with everything there except I'm suprised they say that antihistamines and decongestants are contraindicated for a sinus infection? While steriods can help, I've often seen/heard them contraindicated due to possible addiction. I've always taken 120mg of Pseudoephedrine for nasal congestion, and add Guaifenesin if I'm getting chest congestion; I've certainly noticed an improvement in both, certainly not a deterioration. YMMV I suppose? Just thought that was kind of odd.

That is the "fun" thing about medicine. There are few absolutes. There are exceptions to about everything. Psuedophedrine can open the nasal passages, but the reduction in bloodflow can increase the risk or severity of a bacterial infection. It does not happen to everyone or probably even to a lot of the patients, but the risk is there.

I have to continually change what I do. The learning is ever ending.

[Tperkins]

The big problem with antibiotic misuse is that, it's not done recreationally, or willfully - it's done in the completely sincere albeit incorrect belief that the provider and/or patient are doing the right and appropriate thing to get better. nobody abuses antibiotics like they're narcotics or anything.

I realize most folks here a prepping for a PAW and not planning to use this stuff until then, unless their provider tells them to do so. Some folks, as above, have specific knowledge and direction about when to use things for their situation.

But that's another reason why the whole fish antibiotics thing, or the idea that any antibiotic could be anything remotely like a 'cure-all' makes a some of us grind the enamel off our teeth.

I think I just cracked a molar.

Wouldn't want that to get infected; maybe take some antibiotics? Just kidding.

Anyway, on those IDSA guidelines, I agree with everything there except I'm suprised they say that antihistamines and decongestants are contraindicated for a sinus infection? While steriods can help, I've often seen/heard them contraindicated due to possible addiction. I've always taken 120mg of Pseudoephedrine for nasal congestion, and add Guaifenesin if I'm getting chest congestion; I've certainly noticed an improvement in both, certainly not a deterioration. YMMV I suppose? Just thought that was kind of odd.

That is the "fun" thing about medicine. There are few absolutes. There are exceptions to about everything. Psuedophedrine can open the nasal passages, but the reduction in bloodflow can increase the risk or severity of a bacterial infection. It does not happen to everyone or probably even to a lot of the patients, but the risk is there.

I have to continually change what I do. The learning is ever ending.

Yeah, the practice of medicine is exactly that, practice, theory, whatever you wish to call it. I always call that out with how the medical world has changed their opinions on many things, TQ's for example. One year, it's good to go, next year its a big no no, the year after that, it's okay again. It's all theory based on clinical outcomes, ya know?

[Vicarious_Lee]

First pick is Levaquin. Broad-Spectrum, excellent bioavailability, and even gets into abscesses somewhat. Next is metronidazole, for reasons Liff said.

In fact, that combination taken orally would be pretty romper stomper on nearly anything.

Would it be your pick for MRSA? Where I work, all soft tissue infections are presumed to be MRSA.

Dallas I have no idea. I don't track trends as I'm not in infection control or ID. All I do is look at what grew out, and make a choice based on the sensitivities of the bacteria to the dozen-or-so antibiotics that the lab tells me it's ran, and pick one it's susceptible to.

That's the big problem, shit's a no-brainer for me. On the one hand, dealing with super-resistant pathogens in a PAW likely won't be a problem (though MRSA is well and entrenched in the community), but getting cultures and sensitivities so we know what to best use to treat likely won't be an option, either.

[abelru]

Z-Pack, straight up. Very commonly used, very easy for even the most average Joe to follow, and it's a good almost-cure-all.

I am equally if not more frustrated with my colleagues who collude in this practice, rather than pissing off an admittedly ill and uncomfortable patient by explaining them that an antibiotic won't help...

It doesn't work for most urinary or abdominal infections, btw. Far from first choice for wound/skin, as well.

Forgive my semi-drunken musings, but this is a total flashback...

One of the most memorable moments of when I was a student was during a Family Med rotation, when one of our attendings took us out for lunch.
We were all B.S.-ing about really nothing in particular, which resulted (somehow) in the whole group getting pimped about URI, PNA, etc.

Question: "so what is first-line therapy for bronchitis?"

Several of us chimed in with with mention of all manners of antibiotics.
Azith, levo, doxy, augmentin, biaxin, the list goes on.
A collegial debate ensued which had a second year hotly debating with an intern regarding the cost/efficacy of tetracyclines versus macrolides. pulmonary pennetrance, half-life, side effect profiles. The shit was getting thick.
Lines were drawn and sides were picked. I parked my ass firmly in the macrolide camp, knowing full well that I have seen at least a dozen (lol) cases of bronchitis, and all of them walked with a Z-Pak.

We finish lunch, and head back to clinic. As soon as we got back, I rushed over to my (way overstuffed) coat, and start flipping through Sanford to find the answer, absolutely convinced I will find irrefutable proof that I can show to my attending to show him that I am right, and know more than the PG2.

How humbled I was to read that first line therapy was little more than chicken soup. I wanted to cry. The second year was nearly shamed into retirement.

What I have learned from this episode is that there is a system-wide issue with prescribing antibiotics, especially for respiratory illnesses which has led to the lay-public being convinced they are warranted the minute you cough more than twice.
MAP scores, 'path of least resistance' practice style, time constraints and more have formed an environment where providers prescribe them in huge amounts. And in an educational system which relies heavily on learning by the examples set by your peers and mentors, the next generation is almost guaranteed to repeat the mistakes of many who came before.
The very question posed by this thread, and the fact that there are several others just like it speaks to the pervasiveness and depth of the problem.

In case of emergency, break glass, take antimicrobials!!!

BTW: the only thing I'm giving a blowie for in the PAW is some fucking In-n-Out burgers.