You tested me to see if my childhood recollection of penicillin allergy was still valid. Even though the tests showed I was not allergic my PCP still won’t prescribe it when I need an antibiotic. Why the reluctance?
The simple and short answers are; medical malpractice and labeling. Roughly 10% of malpractice suits are concerning medication errors. Physicians are aware of this. For some reason, once a person is labeled as “penicillin allergic” there is great reluctance to remove this label. As it turns out, 12% of the American population carries this label. However, when academic centers have done studies to confirm this diagnosis only 5% of this group is actually proven to be allergic. So, to look at that in terms of numbers; for every 1,000 Americans 120 carry the penicillin label and only 6 are actually allergic.
The problem is that of these 6 individuals the potential exists for a life-threatening anaphylactic reaction. So, many people (including doctors) choose what at first blush seems to be the safer route: avoid penicillin. Unfortunately, this in not always a safer choice. By denying the patient the “first line” treatment choice it results in utilizing less desirable and problematic antibiotics such as fluoroquinolones, vancomycin and clindamycin. These antibiotics have their own potential to cause medical mischief such as tendon rupture, Clostridium difficile (C. diff) colitis, and the development of super resistant bacteria such as MRSA and VRE (vancomycin – resistant – enterococcus). The University of Oregon has done research into this problem. They posit that roughly 30 million Americans are mislabeled as penicillin allergic. They found that patients so labeled have increased medical costs and longer hospital stays compared with patients not felt to be penicillin allergic. The other dynamic that the University of Oregon researchers studied was the question of cross reactivity between penicillin and a separate family of antibiotics called cephalosporins.
Again, they discovered that most doctors will not prescribe cephalosporins to patients with penicillin allergy because of a fear of cross reactivity. In fact, drug manufacturers include in their package insert the possibility for this interaction even though there is little or no evidence from scientific studies of a cross reactivity. Most recent research would indicate that the small number of individuals who are allergic to both penicillin and cephalosporin have this dual allergy not because of a direct cross reactivity but because being an allergic individual per se raises their risk for developing separate but individual drug allergies.
By: Sasha Klemawesch, MD
Electrically augmented wound healing may seem farfetched. I mean, most people were taught not to stick their finger in the light socket. So, exploiting electricity to help heal wounds may seem ludicrous. But when you think about it, doctors have been using electricity in various forms for years. Even back in ancient Greece, there is evidence of electric eels being used in foot basins to help with circulation and pain. Nowadays, Pacemakers and AICD’s (implantable defibrillators) are literally lifesaving for some cardiac patients. TENS units can provide some relief to some chronic pain patients that feels lifesaving. And ECT (shock therapy) can be life changing in patients with refractory depression.
But how does electricity help in wounds? Turns out, in several ways. A diverse array of studies exists reporting on a variety of forms of electric manipulation. Conclusions from those include: improved surgical results, reduced infection, improved immunity and circulation, shortened healing times, improved flap and graft survival, and novel options for addressing complex and recalcitrant chronic wounds.
Again, you ask, “but how”? Well, electric stimulation leads to increased fibroblast activity (fibroblasts are some of the building blocks of cells). It inhibits the growth of many bacteria, and lowered bacterial load in the wound helps mean less hurdles to wound closure. It increases perfusion to skin and veins, the latter due to increased vascular endothelial growth factor leading in turn to increased angiogenesis (blood flow). And it also causes increased white blood cell migration to the site, especially neutrophils which help in fighting infection and macrophages which can help clean up the debris of the old dead wound parts.
Knowing all this, researchers have created a self-powered electric bandage (all the aforementioned studies utilized externally sourced/applied electricity). Their invention is essentially a bandage containing tiny overlapping sheets of copper and other conductive materials as well as a built in nanogenerator. Everyday movements lead to the sides of the wound moving and thereby sparking tiny electrical impulses across the nodes situated on opposite wound borders. So far only tested on rats, the results are encouraging; wound closure dropped from 12 to 3 days on average. Human subject testing is on the horizon. In the meantime, I’d still stay away from hairdryers in the bathtub.
By: Sasha Klemawesch, MD
Many people have heard of C-diff. If infected, you could be stuck at home in your bathroom with annoying (but benign) diarrhea, or you may wind up in surgery or the ICU with life threatening complications. And while many people have heard of the disease, few are aware of how difficult it can be to eradicate.
Now get ready for a scary fact. You might have C-diff. Yes, you. In fact, up to 3% of healthy individuals are walking around with it right now, a rate that jumps to 1 in 5 people who’ve been hospitalized ending up colonized with it. Our GI tracts are home to millions of bacteria, up to 1000 different species at any given time. But when a good & balanced mix of microbes exists, they all stay in check and actually promote health by doing jobs like making vitamin K, detoxifying chemicals, and augmenting the immune system. They also make sure that “bad” bacteria don’t get out of control and run amok through your bowels.
This is the problem in C-diff; when you are given an antibiotic for something else, say a skin infection, or pneumonia, it doesn’t just target the one culprit bacteria causing that one infection in that one place; it also kills off a multitude of others, including most of the good guys in your gut. When this happens, C-diff becomes the dominant force and starts causing distressing pathology.
You may say, “if an antibiotic caused it, why give me another to fix it?” A good point. Especially because the antibiotics we have to treat C-diff are often ineffective, and up to a third of people will end up relapsing even if the initial treatment helped. C-diff is a “spore former” meaning it leaves little hard-shelled spores all over which antibiotics cannot penetrate, so even if the medicine got rid of the active bacteria, the spores are left behind which germinate new bacteria to then resume infecting your gut and releasing their toxins. It is often a vicious cycle, with subsequent relapse increasing your likelihood of another future episode.
By: Sasha Klemawesch, MD
It may sound crazy, but cure rates for FMT (fecal microbiota transplant) are typically over 90% for recurrent cases. What is FMT you ask? Basically, a poop slushy. Sounds gross, but that’s what it is; poop is taken from a healthy donor who has been thoroughly screened for pathogenic bacteria. It is then filtered, mixed with liquid and administered to the recipient patient in one of several ways; either capsule pills, NGT or endoscopy (tube from the top into the stomach/small intestine), colonoscopy (tube up the behind), or an enema. While we only recently adopted it into standard human medical care, vets have been using it for a century. The idea is similar to that behind probiotics; that if you are restoring the natural flora in your GI tract, this in turn regains the upper hand and tamps down the C-diff. It is becoming more and more commonly adopted into practice, especially at large tertiary centers, but perhaps even more exciting is that now that FMT’s benefits in the treatment of C-diff has been proven, there have been a multitude of off-shoot studies and trials investigating its potential role in the future treatments of inflammatory and irritable bowel syndromes, obesity, diabetes, MD, Parkinson’s, atopic conditions, rheumatoid arthritis, autism and depression. And that’s no BS!