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Amoxicillin is easily one of the world’s most popular and recognizable anti-biotics. It still is the first line of defense against the most common infection known to man. Unfortunately, through the years, it has grown to have a reputation as a cure-all. As a result, the drug has been misused tremendously. The misuse has led to the unfortunate rise in drug-resistant strains of pathogens.

Amoxicillin is a moderate-spectrum antibiotic active against a wide range of Gram-positive, and a limited range of Gram-negative organisms. It is usually the drug of choice within the class because it is better absorbed, following oral administration, than other beta-lactam antibiotics. Amoxicillin is susceptible to degradation by β-lactamase-producing bacteria, and so may be given with clavulanic acid to increase its susceptability. The incidence of β-lactamase-producing resistant organisms, including E. coli, appears to be increasing. Amoxicillin is sometimes combined with clavulanic acid, a β-lactamase inhibitor, to increase the spectrum of action against Gram-negative organisms, and to overcome bacterial antibiotic resistance mediated through β-lactamase production.

Amoxicillin binds to penicillin-binding protein 1A (PBP-1A) located inside the bacterial cell well. Penicillins acylate the penicillin-sensitive transpeptidase C-terminal domain by opening the lactam ring. This inactivation of the enzyme prevents the formation of a cross-link of two linear peptidoglycan strands, inhibiting the third and last stage of bacterial cell wall synthesis. Cell lysis is then mediated by bacterial cell wall autolytic enzymes such as autolysins; it is possible that amoxicllin interferes with an autolysin inhibitor.

Source

The first paragraph just about sums up every answer to questions raised in the previous post.

Putting Amoxicillin on your wound will not help at all!

    Like the article puts it, the drug is absorbed following oral administration. It doesn’t work like an antiseptic when it direct contact with an open wound. Is it harmful to do it? Well, there have been no studies regarding this peculiar practice, but it is a waste.

Self-medication with any unprescribed antibiotic is still a NO-NO!

Most infections and diseases that an healthy human being gets are usually a result of organisms that are self-limiting (i.e. will resolve even without treatment) and using antibiotics in the event of the condition is not only wasteful – it’s also potentially hazardous in the long run.

Let’s all make rational drug use our advocacy!

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… unless it was prescribed! If you are a healthy individual, the cause of your disease is likely to be viral. Garden variety viral infections usually resolve by themselves without the help of drugs. Anti-virals may be used, but given their price and supposed benefit (you’ll get better a day earlier), it can be considered as something non-cost-effective. Obviously, an antibiotic will not work against a virus. Not only are you wasting your money, you could also be diminishing the effect of that drug in future. Let’s say you won the lottery and you do in fact have a bacterial infection that may be relieved by that antibiotic. Chances are, you will not be taking the drug for its intended full course and you’ll just end up building up the bug’s resistance to medicine after you abruptly discontinue taking the pills.

Just like what was repeatedly emphasized in the five class presentations that I’ve posted earlier, it’s in our best interest to promote and observe rational drug use. I’m sure it definitely makes sense to just about everyone, but unfortunately, a lot of people continue to be in the dark as far as the definition of the word rational is concerned. Amoxicillin (and just about every other over-the-counter antibiotic drug) are easily among the most abused and misused drugs in the world today. For some reason, people who have fever think that self-medicating with amoxicillin helps despite the lack of diagnostics to better localize the focus of infection. To some, this may come across as something totally acceptable. After all, the patient may really be benefited with the use of an antibiotic and in the end, he or she may get better thanks to the effects of the drug.

Unfortunately, it’s not that simple.  Just like everything else, bacteria and disease-causing organisms are also subject to the laws of evolution. They also react to environmental stressors (in this case, antibiotics) and through time, these bugs change their makeup to eventually become resistant to the antimicrobial properties of the drugs. Though those changes happen inevitably, we can all play a part in slowing down this process.

 

Why do we need to promote rational drug use?

To put it bluntly, there aren’t enough antibiotics out there. Given the finite set of drugs that we could use against a rapidly-evolving enemy, we are left to responsibly dispense the medicine and make sure that the low-tier drugs get used first before we go all out with the big guns. In the past decade, very few antibiotics have made it out of the labs. Making a new line of antibiotics costs a lot of money for research, development and testing.  If we are not responsible with this, there will come a time when none of our antibiotics would work against the nastiest infections known to man.  Considering that we are seemingly staring a pandemic in the near future, such a proposition of ineffective drugs seems very apocalyptic.

All these nasty little buggers  affect us all and we all share the same weapons against them. If some of us continue to abuse drugs and irresponsibly make the most minor of infections resistant to more drugs, the future can certainly be bleak.

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Today was such a boring day. Half of class hours was devoted to one of the most boring subjects ever (microbiology) and it literally felt like we were caught in a time space warp. Due to the way the seconds dragged after lunch, everybody was pretty much relieved by the time the time the afternoon lectures came to end. All that was left to be done was to meet in groups to discuss the case presentation for the following day. And then it happened.

I stretched out from my chair and my thumb got caught in a huge (5 foot high) industrial fan. My groupmates freaked out ! Run to the sink Benj! Run! I froze as I watched blood seeped out of my cut thumb. Ironically, this was the second time it has happened this year. I cleaned my still bleeding finger with tap water (!) and squirted it with a good amount of alcohol. Needless to say, it’s one of the best things that ever happened that day. I found out that my groupmates had genuine concern for me. They even asked me about my immunization profile for Tetanus shortly after my encounter with the metal-bladed kind.

Next time you’re bored, try sticking your finger into a metal-bladed industrial fan. You’ll never know what can happen!

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It always happens.

Every June, almost all student-bloggers end up bogging down to just blogging twice or event once(!) a week. The work load for the month of June is hardly heavy for any degree program, but due to the relative rise in school requirements and cortisol level (d-oh with summer vacation as the point of comparison), this change in environment is often felt in an exagerrated degree. I’ve struggled to make updates the past few weeks and now, I find myself blogging about the things that I do in school. Come to think of it, I think it would be better if I blog about medical concepts more as long as I communicate it in a more accessible mannet – hopefully less jargons and more pictures! My first two articles of filariasis and Fournier’s Gangrene seemed to have worked just fine so I might actually end up writing similar articles in the future.

As far as my other blogs are concerned, it’s so far so good. I’ve submitted ten articles out of the required sixteen for this month and with a week to go, I’m sure I’ll have those covered real soon.

I’m off to see a play with Gibbs and Ronnie in a while. You’ll definitely read about that here.

Take care everyone. 

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Public Service Advisory: This post contains graphic images that may disturb some people. Reader discretion is advised.

Last week, I almost made somewhat of a bad call by being too biased towards a diagnosis of filariasis over one of Fournier’s gangrene. Thanks to research and a little of analysis, I came to the conclusion that the latter was the more likely disease entity. If you’re a med student (or somebody who has access to a medical book), a quick skim of the index wouldn’t yield much if you’re checking Harrisson’s Internal Medicine. The book only “discusses” the topic briefly. How brief? Try 2 sentences.

In 1883, the French venereologist Jean Alfred Fournier described a series in which 5 previously healthy young men suffered from a rapidly progressive gangrene of the penis and scrotum without apparent cause. This condition, now known as Fournier gangrene, is defined as a polymicrobial necrotizing fasciitis of the perineal, perianal, or genital areas. In contrast to Dr Fournier’s initial description, doctors today know that the disease is not limited to young or male patients, and a causative etiology usually is identified. Source

Yes, you read that right. It’s a disease entity that can potentially part a man from his real bestfriend in a matter of a few days.

Fournier’s disease is a fast-spreading and aggressive infection that eats its way through an immunocompromised body. The people at risk are people with problematic immune systems like people with Acquired Immune Deficiency Syndrome (AIDS), diabetes, those with a history of steroid use and those with certain cancers (i.e. colon, anorectal etc.). It’s a polymicrobial necrotizing fascitis. Let’s break it down to make it easier to grasp. Those three words look and sound pretty daunting when used consecutively.

polymicrobial – it’s an adjective that denotes the influence of multiple pathogens (bugs that make you sick) in a certain disease entity. If an infection is polymicrobial, that might mean that you need to use multiple drugs or those that have a broad spectrum effect to make sure that all of the harmful bacteria get eliminated.

necrotizing – it’s a gerund/adjective that can be used to refer to the process of cell death. Necrosis of course is the death of cells or tissues through injury or disease, especially in a localized area of the body. The prefix necro pertains to death, so if you’re a necrophiliac, that makes you someone who gets really excited in morgues.

fascitis - it’s the inflammation of a the fascia. As a rule of thumb, anything that ends in -itis has something to do with inflammation. Ergo, arthritis is the inflammation of the joints. Carditis is the inflammation of the heart and so on. Almost every solid organ will have it’s -itis term. What’s the fascia? Fascia is a a band or sheath of connective tissue investing, supporting, or binding together internal organs or parts of the body. You have a lot of fascia at the back of your legs – below the butt.

So, what’s polymicrobial necrotizing fascitis? It’s an infection that causes massive cell death due to the invasion of many pathogens in your fascia. This can cause swelling – most notably of the scrotum. In Fournier’s, it’s likely that fever will accompany the infection.

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Last year, my role and commitment to the team was somewhat deficient. It’s very likely that my head wasn’t screwed on the right way. I guess not a lot of people go through what I’m going through with the team now. My first team was a winless team that could barely field in enough players to escape the possibility of losing by default. Being on a losing team for a number of seasons had its “perks” though. I played the entire game and I had the license to do just about everything on the court. At times, I played point guard on offense and center on defense. I got into foul trouble a lot. I got hammered numerous times through out the course of the game. I often drew the ire of other players for playing too physical. ME?! Of all people. I’m so lanky, I dunno why people twice my size often whine on how I push them around. Jeez.

But it was all good. Despite not tasting a win for a good number of seasons, it was fun to be “the man” for a while. There wasn’t a shot that I couldn’t take. I led the team in scoring in the majority of games played and I even had a 28-point game against the Admin team. They weren’t playing defense much, but they, 28 points is 28 points! Hehe

Then came a transition. I was suddenly surrounded by a better cast of players. Some of them were a lot better than me. They weren’t simply your average players. Some of these people had special skills (insane speed and athleticism) that I would never get even if I  practiced for eight hours a day. Fortunately, I was retained in the starting line up as the team’s small forward. At 5 feet 9 inches, I was a fairly tall guy at the three position. I was tall enough to grab rebounds and post up in the middle, but I also had the range to hit the three ball if they needed that.

But my role changed. I wasn’t in the game for offense – we had far better players for that. My role was mainly for defense and hustle. I’ve always taken pride for my ability to block shots and dive for loose balls – despite what my basketball buddies for 10 years would say *hey Emil, Coach Pop, Gilbert, Aius and Bong!*.  I was no longer scoring big. Gone were the days when you could almost always chalk in a double-figure game from me. It was no longer possible. I evolved into a gritty and wily utility player.

What was the perk of being with this team? Hell, we made the finals! I was a starter for a team that made the Finals (I didn’t say champions so we lost)!  I would be extremely idiotic to suggest that my team made it near the top because of my play, but my contributions as someone who started all games and played about 25 minutes a game helped, right?

Then came another change. I had to play for another team. They clearly had their systems ready and to my surprise, they were stocked at my position. The small forwards they have were far more athletic. I had a fairly long reach, but those of the already existing members were phenomenal. One ran like the court like gazelle while one had the strength of an ox. I couldn’t match those qualities.

I had to be successful somewhere else.

I had to be a shooter. No, a sniper that would literally blow the lights out every game. That is what the team  lacks to this point – a solid perimeter option to compliment the already eye-popping play of a Dirk Nowtizki/Tim Duncan play-alike at 6 feet flat (Jenus) , a human highlight reel of a shooting guard (Joguel) and one of the most efficient and unorthodox players I’ve ever seen (Geno).  That’s what I’m working on right now.

 If the last practice was any indication, I’m on the right track. I hit 8 of 10 threes in a scrimmage including seven in a row. Most were uncontested and almost all hit the bottom of the non-existent net. It felt to good that I’m sort of finding more ways to contribute to the betterment of the team now. Hopefully, the improvements continue. All of us want to win badly and hopefully, we’ll get to win more this year.

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