Posted by: notdeaddinosaur | May 26, 2017

Urgent Care Follies

What is it with antibiotics and steroids for upper respiratory infections at Urgent Care these days?

Over-prescribing of antibiotics has been a problem ever since the recognition that uncomplicated upper respiratory infections were almost always viral and would resolve on their own. I like to call the Z-pak (a pre-packaged 5-day course of azithromycin, a macrolide antibiotic) a “Placebo Antibiotic.” It doesn’t help a viral infection, but has relatively few side effects, and the accomplishment of making the patient feel like he’s gotten something for his handsome $15.00 co-pay. Not optimal treatment by any means, but an option for the violently insistent patient you just can’t fight with anymore.

Prednisone, on the other hand…

Steroids are real medicine; not something to f@ck around with. Even the six-day “dose pack” that doesn’t start high enough and tapers down too quickly to do any good when you really need it can cause significant side effects (elevated blood pressure, blood sugar, trouble sleeping, GI upset, stomach bleeding…) and carries the very real risk of making some kinds of infections worse. (Looking at you, Shingles.) Couple that with the, shall we say, questionable diagnostic acumen I’ve observed in many Urgent Care facilities that deign to send me anything, and I’ve moved through bemused, past concerned, coming up on terrified.

If you have a cold, first of all wait a week. Stay home, rest, and drink fluids. Please.

If it’s been longer than that, call me (or your own doctor.) We can find out over the phone (risk factors for strep, pneumonia, other things we can actually do something about) if it’s worth your time to come in or not.

If you absolutely, positively, must go to Urgent Care, please don’t take the antibiotics and the steroids. They are not going to help, and they could very well hurt you. Just because something is “prescribed” does NOT mean it’s a good idea to take.

And if you work in Urgent Care, what the f@ckmuffin is going on there? At this point, you really should be able to resist the siren call of antibiotics, with all the supporting literature available. But steroids? What the actual f@ck is going on with that?

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Responses

  1. Same here in my community. Waiting till they give somebody DKA, or steroid psychosis, or an acute glaucoma crisis. And the zpacks! We have patients that come in colds are not given antibiotics and go to the urgent care because they know the midlevel will give them a zpack. As to what the f%&k is going on I think it sounds like “ka-ching!”

  2. Glad to see you back blogging again.
    On the topic, there simply are too many prescriptions being written. That needs to change but then people, also, have to take responsibility and not expect that everything and anything can be fixed with “a little pill.”

  3. It’s funny. A colleague in Sough Africa bunged up his hand pretty bad, got stitches, but no antibiotics. Told to soak it in hot water as necessary. 3 weeks later, goes home to CO and sees his own doctor #1 response? Looking good, but here, take these antibiotics.

    And, as far as prednisone goes, if anyone with COPD has a cold or other infection, “Let me give you this”whopper antibiotic” and a course of prednisone.” Growl.

  4. thankyou for the informative blog as we started taking medicine even for a minute fever.
    Hair transplant in Indore

  5. The practice of treating viral infections with antibiotics is probably very practitioner-specific. At our urgent care center, we only provide symptomatic treatment if the URI symptoms have been present for less than 7 days. But, of course, it takes more time to explain to the patient, who is demanding antibiotics, the reasons to avoid them. I often resort to relating a story of a C. difficile infection that resulted in a patient’s death to scare them into accepting my treatment.

    We need to address the root cause of the issue: the absolute ignorance of our patients about basic medical/biological realities. No, cold weather does not cause infections (has anyone heard of bacteria and the “germ” theory?).

    It makes no sense to say that “I get this infection every year and it only gets better with a Z-pack.” Does that mean that you are infected with the exact strain of bacteria every 12 months?

    “I never get sick, and I have had this runny nose for 2 days, and I can’t be sick tomorrow because I have a wedding to go to.” Really? Have you NEVER been told that there is no cure for the common cold?

    Of course, the root cause of the ignorance of our patients is the absolutely abyssmal education system that most of them struggle to complete and a lack of accountability. Until we teach children basic medical facts, we’re going to continue to have a system on the brink of collapse (obesity, sleep apnea, diabetes, heart disease – all due to a failure in education AND poor personal decisions made every day).

  6. A Z-pack and a steroid pack are God’s medicines, God’s gifts to man. A Z-pack clears the airway from harmful bacteria and a steroid pack magically restores the breathing and minimizes the hoarseness, the pain and inflammation. Whenever I do nothing and wait for the infection to go away on its own I end up suffering miserably for 2 weeks. Whenever I use the Z-pack and steroids I am back on my feet in a couple of days.Theories are good but actual personal experience is what really counts. Patients are not stupid or uneducated, as some commentators and doctors think, for wanting antibiotics and steroids. We see what works best for us and we can compare which treatment works and which doesn’t. Instead of blaming the patients or trying to scare them with very rare and dubious complications, why don’t you try to listen to them and trust them when they tell you about their own bodies and about what treatment works and what doesn’t work?


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