Tuesday Top of Mind 11/18/25- Robin getting slapped by Batman for saying he needs antibiotics for a cold

Less than a century ago, common illnesses such as appendicitis or pneumonia, or even extremity abscesses were often lethal. That means the infection, that there was no way of stopping, killed the patient.

It was in 1928 that the miracle of the petri dish occurred. Well, some say miracle, I call sloppy lab control. The petri dishes weren’t cleaned before Dr. Alexander Fleming went on vacation. He got back to his lab and the dirty petri dishes to find the newly grown mold that had developed was keeping the bacteria from growing.

Penicillin enters the chat.

But penicillin would worked on many different bacteria. Today we call it broad spectrum.

Then they called it amazing. And wondered what other antibiotics could be found and developed. Sulfa medications soon followed. And then resistances to the antibiotics started appearing.

Really the march to where we are now is fascinating.

There is a really good article. “Antibiotics: past, present and future” by Matthew Hutchings, Andrew Truman, and Barrie Wilkinson. It has good graphs, tables, and illustrations. But it points out the present we are living in and the future we should all fear.

The present that we are all living in is the rise of antimicrobial resistance (AMR).

This is when the causative agents of the infections are no longer susceptible to the antibiotics used to treat them. This means that the drugs no longer work for that infection.

I am not kidding when I call that the scourge of the modern age.

Because when the antibiotics we have are not the right antibiotic to treat an infection we might as well be back where we were 100 years ago. Shit out of luck (SOL).

And dying from appendicitis.

But how did we get here?

From the free and loose prescribing of antibiotics for nearly 100 years.

I have a cold, try these antibiotics. They aren’t the medication for viruses, but hey, it might help.

I feel better, I think I will stop these antibiotics. Yeah, I’ve only taken them for 3 days and it is a 7 day course but I feel better now.

A new friend from another place, let me shake your hand and give you what I might have and pick up what you might have. From the casual contact.

Oh, is that a rescue animal. Can I pet it?

Germs are like people, they want to live. And to do so they mutate and learn to overcome the antibiotics. Worse, yet, they have the ability to learn from other germs that are nearby. Germ A learns to be resistant to antibiotic a because germ B taught it to be so.

It is a huge problem.

This week is Antibiotic Awareness Week, November 18-24. It is meant to raise awareness of appropriate antibiotic and antifungal use. (not for colds, jan!)

Because we are rapidly approaching the cliff where none of the antibiotics will work and limited new antibiotics in the pipeline.

Your mission:

  1. Try rest and fluids for illness first, especially a cold
  2. always finish the course of antibiotics
  3. do not ask for antibiotics for a cold. The reason you feel better is the placebo effect
  4. when your child needs antibiotics for a cold don’t give your leftover ones from last year
  5. listen to the medical professionals about antibiotics

Governments and scientists are working on it. They were slow to wake up to it, and slow to get going, but everyone is aware that this is a problem.

And hope really hard that it is not too late.

Post-it Sunday 12/1/24- A Cultured Kind of Surgery

The post-it reads “Hey doc, are you expecting a different result from a mm away?”

A culture is a lab test that tests for infection in a location where the culture is taken from.

This location can be anywhere in the body. I’ve done cultures on abscesses from the top of a patient’s head all the way down to their toes. Different patients, mind you.

The reason behind doing a culture is twofold. It lets the lab and the surgeon identify the particular pathogen that is causing the infection. It also allows the surgeon to order the correct antibiotics targeting the pathogen. A third possibility is that there is no infection that is causing the symptoms. However, even that is an answer. A negative result and lack of a pathogen is still an answer.

However, this post is about a surgeon who is culture happy. They culture everything. And I mean, everything. Oftentimes there are multiple cultures, within the same geographical area on the body.

My question to that surgeon is why run these expensive tests when the area that is cultured is essentially the same place. I do understand pre and post-lavage cultures. This is when the body part is cultured before irrigation and after to see if there are any lingering bits after being sprayed with the equivalent of a garden hose.

What I don’t understand is the multiple cultures after the incision and before the irrigation. Please help me understand why this is routine for the culture happy surgeon.

Is the pathogen just under incision different than the pathogen 1 mm in? I guess it could be. Especially when there is a verifiable pocket of pus that looks different. And I understand culturing separate body parts, such as the heel of the foot and the knee. But how often does that happen?

And at what a cost to the patient?