Posts Tagged ‘Antibiotics’

Seeing Through Pink Eye

by Marissa Camilon, MD 2011 | camilon@myhousecallmd.com

While it may be better to see life through rose-colored glasses, acquiring pink eye is not the recommended approach. Anyone who has suffered through this highly contagious and (usually) brief condition can testify to the suffering it causes. You’re itchy, you’re watery and you’re incontestably uncomfortable. Your eyes are your window to the world and, as such, you can’t give them a rest for several days at a time while they heal.  In a nutshell, pink eye sucks.  Luckily, it’s pretty easy to treat and usually lasts for a short amount of time.  What you may not know, however, is that the conventional ways to treat it, the ones passed down from your grandma’s aunt’s nanny, may not be what is the best treatment for your eyes.

What it Pink Eye?

“Pink eye” is more commonly known in the medical world as conjunctivitis, or inflammation of your conjunctiva (the moist layer of tissue that covers most of your eye and the inside of your eyelids). There are many causes for inflammation in this area that are broken down into two major categories: infectious and non-infectious causes. Under the infectious category we have conjunctivitis caused by viruses or bacteria.  Under the non-infectious category we have allergic and non-allergic causes (an example of a non-allergic cause is spilling chemicals in your eyes). While studies show mixed results, most physicians in the trenches will tell you that the most common cause of conjunctivitis is viral.  This makes sense since viral conjunctivitis is extremely infectious (it spreads like fires in the Hollywood Hills in the late summer), spread through any type of bodily secretions, especially secretions from the eye.  That’s where those darn bugs have it figured all out, right?  They make our eyes insanely itchy causing us to rub them all day typically right before we touch phones, doorknobs, and other people’s hands.  That’s also the reason that most of viral outbreaks occur in schools or daycare centers (i.e. places where objects can easily go from eye to hand to mouth to who knows where else).

How do you know if it’s serious?

Historically, you decide to visit the doctor (or more commonly you take your child to the doctor) when you notice the tell-tale pink eyes, complete with extra discharge and dried mucus crusting your eye lid closed in the morning (that seems to be the standard diagnostic criteria in town).  Before you completely write it off as “just another episode of pink eye,” there are a couple of things you should keep in mind. First, there can be more serious causes of pink eye than a simple virus so let your doctor know if you:

  • wear contacts

  • have concurrent headaches and nausea

  • have suddenly blurry vision

  • have a very, very strong feeling that there is something inside your eye

Any of these signs can indicate that something more serious is going on and is worthy of sharing with your doctor during your appointment.


How to Treat Pink Eye

Now we return to your doctor’s appointment.  While we all want the “magic bullet” to cure our medical ails, pink eye is another case where this just doesn’t work.  Since most cases of pink eye are viral in origin, antibiotics (i.e. medications that kill bacteria) won’t do anything for it (this little tidbit of information may not be what you have heard in the past).  Previously, antibiotics were generally given to those with pink eye, even when they were suspected to be viral, to prevent any bacterial infection that could occur on top of the viral infection.  Even as late as 1994, treatment guidelines stated that antibiotic treatment was always necessary for that exact reason (the prevention of a bacterial “super-infection”…not as cool as it sounds).  Since then, new research has shown that these bacterial super-infections rarely occur and that antibiotic treatment may actually be harmful. Giving someone antibiotics without any infectious bacteria means exposing normal, “naïve” bacteria to antibiotics that they can build resistance to.  The result is the evolution of stronger, antibiotic resistant bacteria that are harder to treat in the future. In the words of Homer Simpson, “Doh!”

This strategic change in our approach to treating pink eye is still slowly making its way through American society.  One major issue is the long-standing rule at schools and nurseries stating that children should be treated with antibiotics before returning to school.  Their goal is to decrease the number of children who can potentially become infected. Remember that we are most likely dealing with a viral infection that will not be killed by antibiotics.  The only real way to control the spread of viral conjunctivitis is to not share napkins, utensils or cups and, like we’ve heard so many times, by washing your hands!  The second major battle takes place with people who have heard or seen the previous use of antibiotics during cases of “pink eye.”  These people will go to the doctor expecting to be handed antibiotic eye drops and put pressure on their doctor to prescribe them as they did in the past.  Luckily, these two issues can be rectified with education about the self-limiting, viral nature of this disease.

For those sitting in the waiting room, here’s some good news: in the majority of cases, this is a self-limited condition that can be treated symptomatically. That means using over the counter antihistamines, decongestants or lubricating agents to relieve the dryness and discomfort in your eyes.  So while you may not get the “cure” to pink eye at the doctor’s office, you can definitely get some help with the real troublesome stuff so that you can live your life while your body’s immune system does exactly what it was designed to do.

Questions? E-mail the Author: camilon@myhousecallmd.com

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References:

  1. Azar MJ, Dhaliwal DK, Bower KS, Kowalksi RP, Gordon YJ. “Possible consequences of shaking hands with your patients with epidemic keratoconjunctivitis.” Am J Ophthalmol 1996, June; 121 (6): 711-2.

  2. Bennett C, David S. “Treatment of viral conjunctivitis in children/in reply.” American Academy of Family Physicians 2003; 67 (9): 1873-5.

  3. O’Brien T, Jeng B, McDonald M, Raizman M. “Acute conjunctivitis: truth and misconceptions.” Current Medical Research and Opinion 2009; 25 (8): 1953-61.

  4. Rose P, Harnden A, Brueggemann A, Perera R, Sheikh A, Crook D, Mant D. “Chloramphenicol treatment for acute infective conjunctivitis in children in primary care: a randomized double-blind placebo-controlled trial.” Lancet 2005; 366: 37-43.

  5. Weiss A. “Acute Conjunctivitis in Childhood.” Current Problems in Pediatrics 1994; 4-11.

23

06 2010

Would you like some beer with your prescription?

by Tania Houspian, PharmD 2011

It’s inevitable and happens at least twice a month.  Plans will be made to go out to a bar with friends and, as the first cocktail is being ordered, someone remembers that they’re on antibiotics for an infection they’d rather not talk about. The question is raised about whether or not it’s OK to drink alcohol with that particular medication.  At that point, everyone turns to the friend with some form of medical training and asks, “So can I drink or what?” Members of the House Call, MD staff have experienced this so often we’ve started to avoid going out for drinks with infection-prone friends.  What a loaded question!  If the answer is, “No”, then the friend will spend the rest of the night pouting about not being able to drink and secretly blame the messenger for it.  To avoid those awkward conversations, we’d like to take a moment and explain why sometimes it better to put the drinks aside when on certain medications.  We apologize in advance for your drink-less night out.

Why does alcohol interact with certain medications?

Alcohol is broken down by two parts of your body: your stomach and your liver. When that shot of whiskey reaches the stomach some of the alcohol is broken down and the rest is absorbed into your blood stream. From your bloodstream, the alcohol is delivered to your liver via the portal vein.  In the liver, about 10% of the remaining alcohol is broken down. The remaining alcohol is passed back into your bloodstream and is free to create all those magical affects alcohol has on your brain (i.e. thinking you’re a better dancer than you really are, being exceedingly friendly with strangers, etc.).  At any of those stops that alcohol makes in your system (stomach, liver or brain) there is a possibility for it to interact with any medications that may possibly be taking the same path (1).  Below we’ll go through different classes of medications, covering specific medications from each class and how they interact with alcohol.

Class: Antibiotics/Antifungals

Medications: Metronidazole, Nitrofurantoin, Tinidazole, Ketoconazole, Cycloserine, Cefoperazone, Cefotetan, and Griseofulvin

Just a shot of vodka along with any of these medications and you may be hugging the porcelain throne earlier in the night than you had planned. When mixed with alcohol, these medications can cause a violent reaction in your stomach called a “disulfiram-like reaction.” This reaction results in a sudden increase in heart rate, turning beet red, upset stomach, nausea, vomiting and, in worst case scenarios, death (2).  Antabuse is the name of a medication whose main component is disulfram. When people want to quit drinking they are prescribed Antabuse so that if they do give in to their urge to drink they’ll have a violent reaction to the alcohol.  The smart alecks in the crowd are now thinking, “Well I’ll just make sure to separate my antibiotic and alcohol by a long enough interval so that they’ll never meet in my stomach! I win!”  We hope you can define a “long enough interval” (and if so, let us know) because everyone’s stomach empties these medications at different rates.  As such, we can’t even being to make recommendations as to how much time you should allow for so that none of the antibiotic will meet the alcohol.  The bottom line is that if you mix the above medications with alcohol, you’re asking for some serious punishment.  You can’t say we didn’t warn you.

Class: Antihistamines

Medications: Loratadine, Fexofenadine, Diphenhydramine, Desloratadine, Loratadine, Brompheniramine, and Cetirizine

Having read Attack of the Common Cold, you know that antihistamines can help with a lot of cold symptoms.  Since they’re available to buy at the pharmacy without a prescription, some people make the mistake of assuming they’re completely safe and won’t interact with other medications or alcohol.  We are sorry to say that this assumption is wrong.  On their own, antihistamines can cause some drowsiness.  When mixed with alcohol, you might as well tuck yourself in for the night.  Aside from making you drowsier, it’s also possible to become dizzy from a drop in your blood pressure.  Dizziness can lead to falling and falling leads to all sorts of serious injuries (i.e. broken bones, concussions, etc.)(2).  Antihistamines are found in all sorts of cough, cold, and allergy combination drugs like Nyquil so read the back of the label and see if any of the above medications are in there.  We don’t recommend that you take antihistamines and drive until you know their affect on your level of alertness.  If you’re going to drink and take antihistamines, absolutely do not drive (not that you need to be reminded that you should not drink and drive!).

Class: Cough Medications

Medication: Dextromethorphan (Robitussin)

If you’ve ever had a cough and taken Robitussin, you know how sedating it is.  Imagine mixing alcohol with that.  Two words: lights out.  Mixing the two can lead to hallucinations and strange behavior (more so than alcohol alone).  While this may sound like fun to some people, believe us when we tell you that it is dangerous and harmful to your brain (2).  Don’t do it.

Class: Heartburn Medications

Medications:  Nizatidine, Metoclopramide, Cimetidine, and Ranitidine

Heartburn is very unpleasant and we completely understand your need to alleviate that toxic feeling with medications. You pop a Zantac (Ranitidine) and start to feel better so you decide you will join your friends at the pub.  What can you expect to happen after your second vodka tonic?  Nothing good.  Your heart rate will increase suddenly and so will your blood pressure.  Imagine how the heartburn made you feel and amplify that ten-fold. In addition mixing alcohol with these medications can increase the affect alcohol has on you. If you’re someone who usually feels tipsy after six drinks you may start feeling not so great after two.  This happens because the heartburn medications decrease the breakdown of alcohol in your stomach so your body is exposed to more alcohol than it normally would be. In turn, alcohol inhibits the metabolism of the heartburn medications so you experience more severe side affects from those medications (the increased heart rate and blood pressure) (2).

Class: Pain Relief

Medications: Ibuprofen, Naproxen, and Aspirin

Whatever the source of pain (cramps, muscle pain, hangover, headache, etc.) most people reach for one of these trusty painkillers.  Aspirin has lost some of its popularity as a painkiller but Ibuprofen and Naproxen are gaining in popularity due to their anti-inflammatory properties that help with lots of different sources of pain.  How do these trusty pain-alleviating friends of ours interact with alcohol?  Ibuprofen, Naproxen, and Aspirin all disrupt the lining of your stomach and add to the erosive affects of alcohol.  Combine the two and you asking for some serious stomach pain. Together they can completely disrupt the lining of your stomach and allow the acidic contents of your stomach to reach the stomach tissue.  Long-term combination of alcohol and these agents can lead to bleeding in your stomach (a.k.a. gastrointestinal bleeding). Not fun and filled with long-term consequences.  It’s generally recommended that you separate these agents and alcohol by 8-10 hours or play it safe and don’t combine them in the same day (1).

Class: Antipyretic (Anti-Fever)

Medication: Acetaminophen (Tylenol)

Tylenol can be used for both pain relief and to reduce fever. It gets its own separate section from the other pain relievers because it comes with an entirely different risk when combined with alcohol. Tylenol, like alcohol, is broken down by the liver. When Tylenol and alcohol meet in the liver, the alcohol causes Tylenol to be broken down into a toxic compound.  This toxic compound causes the death of liver cells!  Did your liver just quiver out of fear? We don’t blame it.  Long-term combination of alcohol and Tylenol can cause liver failure, meaning that you’ll ultimately need a liver transplant.  Not good.  Avoid taking more than 4 grams of Tylenol a day and absolutely do not drink when taking Tylenol (1).

Class: Antidepressants

Medications: Phenelzine, Isocarboxazid, and Tranylcypromine

The antidepressants listed above are from the Monoamine Oxidase Inhibitor class (MAOI’s for short, we love acronyms in the medical world).  They have lost popularity in recent years because of the many interactions they can have with food and alcohol.  Aged foods (think salami, aged cheeses, etc.) and aged drinks (wine is the main culprit here) contain a compound called tyramine.  The metabolism of tyramine is prevented when someone is taking MAOI’s so the tyramine builds up in your body.  When tyramine builds up, it causes a sudden increase in heart rate and blood pressure that we call a hypertensive emergency (1). Yes, the kind of emergency people end up in the hospital for.  So if you are taking any of these antidepressants, do not drink aged alcoholic beverages.

Class: Sedatives

Medications: Diazepam, Lorazepam, Zolpidem, Eszopiclone, Estazolam, Ramelteon, Phenobarbital and Temazepam

The entire point of these medications is to help people fall asleep. Add on the sedating affects of alcohol and you’ll have an extremely un-alert person. This might not sound like reason enough not mix them with alcohol since being extra sleepy is something an insomniac may want.  However, the downside is that you may become completely unaware of your actions and experience amnesia. On the other hand some people become aggressive and anxious due to combining these medications with alcohol (2).  The reaction can vary from person to person.  Even with the variance among individuals, all the manufacturers of these medications clearly warn against taking these medications with excessive amounts of alcohol.

Class: Opioid Pain Killers

Medications: Morphine, Oxymorphone, Meperidine, Methadone, Propoxyphene, Oxycodone, Hydromorphone, and Codeine

Generally prescribed for serious pain, the consequences of mixing these medications with alcohol are serious.  Like with the sedatives, mixing these medications with alcohol can cause increased sedation, amnesia and loss of control.  If that’s not enough to scare you then maybe the fact that you may stop breathing will.  Opioid painkillers cause respiratory depression (decreased breathing) and alcohol adds to that affect (1).  It is this combination of painkillers and alcohol that has claimed the lives of several celebrities in the past.

There are a lot of other medications that interact with alcohol but the medications above are the most commonly used in our society.  Never assume it’s safe to combine medications or take medications with alcohol until you check with your pharmacist or doctor.  One night of fun is not worth any long-term damage you may cause your self.  The next time the answer is, “It’s probably best not to drink while on that medication,” trust us…we’re on your team.  We’ll even take you out for a drink when you’re medication-free.

Questions? E-mail the Author: houspian@myhousecallmd.com

References:

1.    Alcohol Related Drug Interactions. Pharmacist’s Letter/Prescriber’s Letter. Jan 2008. Vol 24.

2.    Harmful Interactions: Mixing Alcohol with Medicines. National Institute of Alcohol Abuse and Alcoholism. 2007.

19

06 2010

Vaginas: An Abbreviated Owner’s Manual

by Sarah Gilman-Short, MD 2010 | sarah@myhousecallmd.com

Almost every woman has, at one time, experienced that “Ummm… something’s not quite right down there…” sensation. Today we’ll be discussing three cases of vaginas gone wrong – Bacterial Vaginosis, Candida Vulvovaginitis, and Trichomoniasis. Not the sexiest part of womanhood, but often an unavoidable aspect of it. All three have simple treatments and sound much more sinister than they actually are.

Firstly, let’s just say that, contrary to what some people (even some male doctors) believe, not all vaginal discharge is abnormal. Happy, well-adjusted vaginas can regularly release a small amount of milky, whitish, or clear fluid daily.  This fluid is made up of sloughed off cells from the vaginal lining (vaginal cells slough off just like your other skin cells). The color and consistency of the fluid can change with your menstrual cycle. Yes, it’s true – the vagina is a self-cleaning organ. And even though it may be slightly unpleasant to think about, normal vaginas are full of bacteria (just like many other places in the body…your nose, for instance, is packed full of bacteria). Every woman’s “vaginal flora,” as we medical folk call it, is made up of a personalized balance of different species of bacteria, kind of like how every forest has a slightly different mix of foliage. Most vaginas are in a peaceful symbiosis with Lactobacillus acidophilus and Staphylococcus epidermidis.

Things go wrong when this delicate vaginal balance is disrupted. Here are some ways this could happen:

  • Douching: We thought that people stopped doing this in the seventies, but it turns out that it is still popular in some social circles. A word from the wise: Don’t do it! It’s never a good idea – you are flooding your personal space with a bunch of annoying, irritating chemicals that will make your vagina unhappy and make it easier for that delicate balance to be disrupted. Also, if you have a STI, (and you might not even know it if you do) douching can push the evil bacteria into your uterus and fallopian tubes in an ugly, infectious tidal wave, making the problem much, much worse. The best way to clean down there is with some gentle soap and water on the outside. Also falling into the “no no” category would be other irritants such as hygiene sprays, bubble baths, and perfumed detergents. Your vagina does not have to smell like flowers!

  • Antibiotics: Remember the idyllic forest analogy? Taking antibiotics can kill the healthy bacteria your vagina likes and needs, making room for other bacteria or yeast that your vagina hates. But of course, this isn’t a reason for not taking antibiotics if you really need them. An imbalanced vagina is easier to treat than Scarlet Fever.

  • Contraception: Oral contraceptive pills, IUD’s, condoms, and spermicide (especially nonoxynol-9) have been associated with increased yeast infections. Once again, this is not a good reason to stop using contraception – yeast infections, though annoying, are much less annoying than unwanted babies and incurable STD’s.

  • Health conditions: Diabetes, pregnancy, or infections can mess with your vaginal flora.

  • Sluttiness: Just kidding, we don’t judge – but having unprotected sex can put you at high risk for a lot of bad things, including Trichomoniasis.

  • Who knows? Women can get BV or yeast infections out of nowhere, for no identifiable reason whatsoever.  It sucks, but there’s a lot that we doctors just don’t know.

Bacterial Vaginosis (BV)

BV is a very common cause of vaginal annoyance – a third of women who visit their doctor complaining of a vaginal issue end up being diagnosed with BV. Although almost half of women with BV have no symptoms at all, most complain of a fishy-smelling discharge that can be yellow, creamy white, green, or gray (have we ruined your appetite yet?  Our sincere apologies). They can also have some minor itching. No one knows the exact cause of BV, but we know that somehow there is an overgrowth of new, annoying bacteria in the vagina, usually Gardnerella vaginalis, Mobiluncus, or Mycoplasma hominis (the can be seen in the picture to the right…the little dark spots mixed in with the large healthy cells are the unwanted intruders). BV can be more likely to rear its ugly head when a woman has been involved with a new sexual partner, and studies have shown a concordance of BV between lesbian partners; however, there is no clear evidence that it is sexually transmitted.

Candida Vulvovaginitis (a fancy term for a yeast infection)

Candida is a yeast – yes, similar to the yeast that makes your bread and beer delicious – that is present on many people’s skin, but can make vaginas exceptionally angry. This is the type of yeast that many women self-treat with over-the-counter creams but it is, in fact, less common than BV, accounting for about a quarter of the women who come to the doctor with vaginal symptoms. Women with yeast infections often have a thick, curd-like white discharge that kind of smells, well, yeasty. Unlike BV, yeast infections can make your vagina and vulva notably painful, itchy, and red. As we said before, many women will try over-the-counter creams but, if for some reason the symptoms persist or come back, it is important to see a doctor and make sure there isn’t something more serious going on. Studies have shown that most women aren’t very good at diagnosing yeast infections on their own so don’t hesitate to go in for a check-up if you’re unsure.

Trichomoniasis

Trichomoniasis is caused by a little protozoan with a tail (named Trichomonas) that swims around in seminal or vaginal fluid, causing mischief. Trichomonas, although cute, is without a doubt an STI, and can be easily prevented by wearing condoms with every sexual encounter. Trichomonas can live on objects like sex toys and towels and can also be found in urine. Women with Trichomoniasis usually have a significant amount of thin, discolored, foamy discharge, as well as a strange odor and itching. When the infection gets really bad, it can cause fever and lower abdominal pain (but these can be symptoms of other serious infections as well). Trichomonas also likes company – a third of women who have it will have another STI at the same time.

Your Take Home Message

Vaginas can be rather finicky and complicated. Happy, healthy vaginas have their own natural balance of bacteria and anything that disrupts that delicate balance can cause itching, discharge, or odor. If you think that your vagina’s balance is off, it’s a good idea to see a doctor. With a quick swab of your vagina (you don’t usually need a speculum for this) and examination via microscope or laboratory, he or she can diagnose the problem and treat it accordingly. All three conditions can be cured quite easily so there’s no reason to try and fight it off alone. We’re here for you… might as well let us help!

Questions?  E-mail Sarah: sarah@myhousecallmd.com

12

03 2010

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