Aging Begins at 30

Treating the Bacteria that Bug Us

Bacteria don't think. They're just there in billions to take advantage of human errors. Too much antibiotic or too many given for too long leads to trouble. The invading organism gets wiped out, but so does our protective mantle of friendly organisms. The most commonly available fill-in organisms are the multitudes found in the stool. They stain pink with Dr. Grams stain so they are called gram negative and they often invade the vacuum created by antibiotic misuse. You can see why doctors sometimes refuse to give you an antibiotic for a viral cold.

Using antibiotics with pizazz involves following a plan. Mine is a five part plan which starts with penicillin, the first wonder drug. It takes care of most round gram positive bacteria. These are Dr. Gram's purple ones under the microscope such as the streptococci of sore throats, or the pneumococci of pneumonia. Penicillin also kills gram positive rods but they're as rare as hen's teeth. Penicillin kills most gram negative cocci that cause gonorrhea and epidemic spinal meningitis. Penicillin also kills corkscrew organisms such as the spirochete of syphillis. However, one has to learn the exceptions such as gonorrhea from the Far East or the newish hospital invader Staphylococcus epidermidis.

My second approach is how to deal with staphylococci (purple grape-like clusters of gram positive cocci). A very few are still susceptible to penicillin, but I start with a modified penicillin such as nafcillin or if the patient is allergic to penicillins I use a cephalosporin, penicillin's altered cousin. Sometimes I have to use vancomycin (from a far eastern fungus) given intravenously.

My third question "Could this be a minor gram negative rod infection?" Could it be a bladder infection? A family of drugs, the furadantins which are derived from corn cobs, or perhaps a sophisticated mixture of sulfas can be used combined to avoid crystalizing out in the urinary tract.

Fourthly, in some cases, treatment is guided by the overwhelming stench of the pus, that is anaerobic infections (grow in the absence of oxygen). This happens with a perforated gut or abscesses in brain lung or belly or in the gangrene seen in some diabetics. They need clindamycin or metroniadazole (flagyl), or one of the newest so-called "third generation cephalosporins."

My fifth tretament strategy is against the hardest group to cure. The antibiotic-resistant gram-negative rods originally from the colon which have been passed back and forth in closed populations such as hospitals and nursing homes.

I carry a kind of crib sheet in my wallet called a "Guide to the choice of antibiotics" in my own hospital; not any other. The guide tells me, biannually, how twelve difficult to treat gram-negative organisms (the pink ones) respond to twelve different antibiotics. I use this mostly for hospital or nursing home acquired pneumonias or wound infections.

Strategies like this one enable physicians to choose appropriate treatment for bacterial disease. If a mistake was made, was it the wrong diagnosis, the wrong drug, the wrong dose, or too much antibiotic for too long.

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See related Patient Topics Antibiotics, Bacterial Infections, Infection Control, Infections, Procedures and Therapies or Safety.

See related Provider Topics Bacterial Infections, Infections, Procedures and Therapies or Safety.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

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