Anti-biotics. What Is The Correct Course Length

[Riley'sLife]

I am about to take some Amoxicillin to clear up a long standing middle ear infection. Anyone have some definitive facts about what is the duration of a complete course of anti-biotics. I have received conflicting advice from several physician and pharmacists in Thailand (surprise surprise!). I was even told yesterday by a doc I thought would know better, to "take for one week but it's ok to stop if the problem clears up before that." Now, where I come from, that is considered anti-biotic mis-use, and can result in bacteria becoming resistant to anti-biotics. All I can find in my net searching so far is about dosage and nothing specific about how long to take the Amoxicillin. Help!

Cheers Rick

[londonthai]

you should not take any antibiotics without prescription - go to the doctor you trust, who would check your medical condition, what culture of bacterias in your blood you have and whats the level of CPR (antibodies in blood).

the pharmacist knows medicines but doesn't know your blood results and doesn't know that much about pathology.

The serious infections in a range of 150 CPR and more (usually hospitalisation) need some 2 weeks 3x1 of clavulanic acid 125mg. During the course of the treatment you should check your CPR level even on a daily basis (that's how they do it in hospitals) as well as to check regularly your body temperature. On basis on that a good doctor will be able to adjust your medicines.

by self-prescribing antibiotics you might end up in a more serious condition than you have now.

Edited October 2, 2006 by londonthai

[backflip]

You don't trust the doctors or the pharmacists, but you trust us....

You should never stop taking a drug when you feel better. Just because you feel "better", it doesn't mean that all of the infecting bacteria has been killed. The remaining bacteria can grow, and become resistant to the drug you are taking.

[h90]

I am about to take some Amoxicillin to clear up a long standing middle ear infection. Anyone have some definitive facts about what is the duration of a complete course of anti-biotics. I have received conflicting advice from several physician and pharmacists in Thailand (surprise surprise!). I was even told yesterday by a doc I thought would know better, to "take for one week but it's ok to stop if the problem clears up before that." Now, where I come from, that is considered anti-biotic mis-use, and can result in bacteria becoming resistant to anti-biotics. All I can find in my net searching so far is about dosage and nothing specific about how long to take the Amoxicillin. Help!

Cheers Rick

a usual time is after the infection is OK 3-5 more days to be sure that they are all dead and don't come again with resistance. That is meant for a general infection, not sure if the ear is different. As well it might be difficult to tell when the infection is gone.

And yes never trust the docs not the pharmacists neither in Thailand nor in Europe.

Just a few days I got the wrong tablets from the pharmacist in a plastic bag and only due to my experience I found out they are wrong.

[Riley'sLife]

Thanks guys. Just to clarify.. I'm not self prescribing. I was issued with 500mg Amoxicillin by a Thai doc. Because he prescribed 5 strips (each one enough for 2 1/2 days at 3 capsules/day) that is enough for 15days, and a course is usually 5 days, I queried this. I have come across this before and Thai doctors seem to lack awareness of anti-biotic resistance. backflip managed to provide information that most Thai doctors seem unaware of, not much help to me though backflip, as I had already stated the facts that you mention, in my original posting.

I am not taking a beta-lactamase inhibitor (clavulanic acid) combined with amoxicillin as I don't have a resistant strain of bacteria, as far as I am aware. I have been diagnosed with serous otitis media. Commonly known as swimmer's ear, I believe.

As far as trusting Thai doctors and pharmacists.... well, so far the replies to my post on this forum have proved more professional than the answers obtained from the Thai "professionals" !!

So, as I need a pacemaker fitting soon.....anyone interested in fitting it?

[h90]

Thanks guys. Just to clarify.. I'm not self prescribing. I was issued with 500mg Amoxicillin by a Thai doc. Because he prescribed 5 strips (each one enough for 2 1/2 days at 3 capsules/day) that is enough for 15days, and a course is usually 5 days, I queried this. I have come across this before and Thai doctors seem to lack awareness of anti-biotic resistance. backflip managed to provide information that most Thai doctors seem unaware of, not much help to me though backflip, as I had already stated the facts that you mention, in my original posting.

I am not taking a beta-lactamase inhibitor (clavulanic acid) combined with amoxicillin as I don't have a resistant strain of bacteria, as far as I am aware. I have been diagnosed with serous otitis media. Commonly known as swimmer's ear, I believe.

As far as trusting Thai doctors and pharmacists.... well, so far the replies to my post on this forum have proved more professional than the answers obtained from the Thai "professionals" !!

So, as I need a pacemaker fitting soon.....anyone interested in fitting it?

I studied Biotechnologie (Masterdegree) and only thouched human medicin a little bit at university, but that is more than enough to understand that most docs have no idea on medicin, they have like a big book: These symptoms this tablett without knowing what they do and still a lot give antibiotica if you have a virus (not helping at all) or speaking about killing a virus (you cant kill something which is not alive (a virus is not living)).

Of course I have also seen very very good doctors, but it is not different than a mechanic for repairing cars, some are very good some have no clue on what they are doing.

No question if you have something serious you should visit a doc or you risk your life, but a doc is not god and it is your life you risk.....

Good luck for your ear.....

[Vespa]

I find interesting that doctors are not prescribing antibiotics as wonder cures anymore or at least seem slightly reluctant to do so.

As a kid all I can remember doctors prescribing antibiotics for every little minor infection.

[PeaceBlondie]

It depends, and even some of the best Western-trained experts won't know even after they've done blood cultures, tests, and invasive surgery!

londonthai mentions a test that he calls "CPR" but maybe he means CRP. My CRP stayed around 24 for many months (it shouldn't be any level, one doc said), and my ESR ranged from 88 to 33, until after the surgery; then it was 18, still too high.

I went to 7 Thai doctors, consulted a friend of mine (Ph.D. bacteriology, Edinburgh), etc., including some of the best Western-trained physicians in Thailand. Not a clue as to what it was. Six different antibiotics, almost continually (one drug at a time), and today makes the first day since December that I'm not on antibiotics.

Tests? They don't like to do tests. I've heard antecdotes from experts that even the best medical labs in LOS can't calibrate their instruments.

Even in a big medical center in Houston, Texas, the opening remark of my infectious disease expert (after I'd almost died from blood poisoning, twice) was "I can't help you." Fortunately, I'd been cured by some drug during the second emergency room episode.

I learned in the USA that the standard antibiotic course should run 14 days, but my surgeon said yesterday he knows of a Thai who's been on antibiotics for a deep infection for over 20 years now.

[george]

Thanks guys. Just to clarify.. I'm not self prescribing. I was issued with 500mg Amoxicillin by a Thai doc. Because he prescribed 5 strips (each one enough for 2 1/2 days at 3 capsules/day) that is enough for 15days, and a course is usually 5 days, I queried this. I have come across this before and Thai doctors seem to lack awareness of anti-biotic resistance. backflip managed to provide information that most Thai doctors seem unaware of, not much help to me though backflip, as I had already stated the facts that you mention, in my original posting.

I am not taking a beta-lactamase inhibitor (clavulanic acid) combined with amoxicillin as I don't have a resistant strain of bacteria, as far as I am aware. I have been diagnosed with serous otitis media. Commonly known as swimmer's ear, I believe.

As far as trusting Thai doctors and pharmacists.... well, so far the replies to my post on this forum have proved more professional than the answers obtained from the Thai "professionals" !!

So, as I need a pacemaker fitting soon.....anyone interested in fitting it?

I had a nasty middle ear infection (Otis Media) last december, and was prescribed Amoxycillin (Augmentine) 750mg 2 times per day for two weeks. This was from an International hospital. Amoxycillin is one of the best cures for ear infections, but it is a very powerful drug. Caution!

[cathyy]

I'll second the two weeks. If this is a chronic problem it will not be cured after a week or ten days. I once took antibiotics for a full month to get rid of a chronic sinus infection -under the Doc's supervision. My only question is whether the Amoxicillin is effective against the particular infection you have. It is the standard treatment for ear infections, though, and is used until it is no longer effective for a person, at which time they move on to a stronger antibiotic, usually a cephalosporin.

[Crushdepth]

I had a nasty middle ear infection (Otis Media) last december, and was prescribed Amoxycillin (Augmentine) 750mg 2 times per day for two weeks. This was from an International hospital. Amoxycillin is one of the best cures for ear infections, but it is a very powerful drug. Caution!

I had some nasty side effects with this one - I was on a heavy dose (1000mg/day) for 2 weeks and by the end of that I had a nasty taste in my mouth and my skin was flaking off.

I agree with 2 of the points raised above - i) most doctors don't like to do tests and take their 'best guess' as to what is wrong, so they ii) often prescribe something completely useless or inappropriate (just 'keep trying' different things until something works).

That's in Bangkok. Out in the provinces the situation is worse - they'll give you whatever it is that they have in stock.

[Sheryl]

Usual course of treatment with amoxicillin is 7 - 10 days for simple infections, 2 weeks for more difficult ones. Althopugh it is common in Thailand to give only 5 days that is a questionable practice; 5 days is the absolute minimum course and many infections will not have completely resolved by then.

For a stubboirn inner ear infection I would go with the 2 week course. Which seems to be what the doctor had in mind if he ptrescribed 15 days worth. Take the full amount prescribed. If it still doesn't clear up, consult an ENT specialist as it may be a resistant organism.

[Riley'sLife]

Thanks to all for the informed content of your replies. I think I now feel more at ease with the idea of taking the prescribed dose for the 15 days as prescribed.

The ear problem was treated previously about 5 months ago by a short 5 day course of Amoxy which seemed to clear it up until I developed a huge cold following a trip to Songkhla hospital cardio unit last month. All the hosp staff were unusually wearing masks that day, which they never had done before, so there was obviously something being passed around. Pity they didn't issue masks to all the waiting patients too! Anyway, this cold was a real head cold and now it's gone I'm left with the ear infection again. Symptoms are a watery, pale yellow discharge and a crackling sound in the ear on swallowing, and associated mild loss of hearing. Exactly the same symptoms as before. No fever or other symptoms.

George, did your otis media clear up ok after the amoxicillin? Do you recognise the symptoms I mention above?

Thanks again guys.

Cheers, Rick

[george]

George, did your otis media clear up ok after the amoxicillin? Do you recognise the symptoms I mention above?

Thanks again guys.

Cheers, Rick

Yes, it worked fine, and I have never had any problems since then. Same symptoms as you, very scary. I got my ear infection while diving too much in a pool.

[Riley'sLife]

Looks like I'm on the right treatment track too then! Mine originally began in Costa Rica and became worse when I returned home to Thai. Pleased to hear it worked well for you.

Cheers, Rick

[bina]

wanted to add:

recently asked the family doc at the kibbutz why veterinarians give antibiotics for 3 days to animals, and then continue for another two to seven days if problem persists, but w/ people, the lenghth is always 7 - 10 days standard...or more

his answer: money... drug manufacturers play on the safe side and also make more money if more drugs are used... he says that there are docs now that do give for only three days, recheck, and may continue to give more days, or not... depending on age, health and severity of problem, and type of bacteria /antibiotic...his info came from several studies but cant remember the references (he did reference them to me)... it was a question i asked when having sinus infection and asked for antibiotics... many of the younger (newer) israeli doctors are becoming very anti-antibiotic, prefering monitoring and treating symptoms (obviously not for documented cultured case of infection needing antibiotics) in things like ear infections, sinusitis, etc

use ear plugs that are specially made to fit YOUR ears; prevents the pool ear infections

not totally relevant just thought it was interesting

(i'm allergic to many kinds of antibiotics so have to stick with tetras and doxis, so try to minimalize usage for obvious reasons)

bina

israel

for ear infections there is a tendency nowadays not to give antibiotics unless a culture has been performed as many ear infections (notably pediatric) are viral in nature...

[BambinA]

If i were you doctor ,I would swab your ear 's dischage and culture it .. so i know what should i select the ATB for you

for the course lenght can be 7 - 45 days depends on your sign

Augmentin (Amox + Clavulinic acid ) is good for gram (+) , beta-lactamase bacteria (Streptococcus spp. ,staphylococcus spp.)

If you get gram (-) bacteria as Pasteurella spp. i would choose fluoroquinolone as norfloxacin , enroflox.

[drugshome]

<snip>

Amoxil is an antibiotic in the class of drugs called penicillin. It fights bacteria in the body. Amoxil is used to treat many different types of infections, such as tonsillitis, pneumonia, ear infections, bronchitis, urinary tract infections, gonorrhea, and infections of the skin. Amoxil may also be used for other purposes.

<snip>

Edited February 20, 2007 by Jai Dee
Spam links deleted, useful information retained.

[Sheryl]

The correct antibiotic depends on the type of bacteria and which drugs it is sensitive to. Doing a culture of the pus would tell that. Since a culture takes time, doctors often give an antibiotic that is known to be effective against most strains of the most common bacteria for that type of infection. Amoxicillin for an ear infection would be a good example, since the bacteria which most commonly cause ear infections are usually sensitive to amoxicillin.

The key words are "most common" and "usually". There is always a possibility that the infection is being caused by a less common bacteria, or that the bacteria is resistant to amoxicillin. The last problem is particularly likely if the patient has previously had incomplete courses of amoxicillin, as the OP did.

If an infection does not respond to the "usual" (i.e. selected based on probability without benefit of culture) antibiotics then a culture should be done.

OP -- if your infection seems to be improving, then stick with the amoxicillin for the full 15 days or 3 days after all symptoms are gone, whichever is longer.

If it does not seem to be improving, go back to the doctor and insist on a culture to determine the correct course of antibiotics.

All readers: don't put up with a lot of trial and error in treatment of infections....which Thai doctors are particularly fond of. (Often because they work somewhere that doesn't have a lab able to do cultures...this problem you can avoid by consulting a doctor at any reasonably large hospital). It's OK to try a second antibioitic while awaiting the results of the culture to confirm, but my rule of thumb is that after one failed course of antibiotics a culture should be done if at all possible. Technically, if one really wants to go by the book, a culture should always be done in the first place....but I see no harm in an initial trial of t\an antibiotic which is probably effective if the patient is not too seriously ill. But not more than one such trial.

[Artisi]

I don't take any drugs - for a infection such as this I will fast - 10 -15 days and let the body do what it is good at and designed to do - cure itself without drug intervention, however if taking drugs is the way for you and for an inner ear infection I would suggest a minimum of 14 days - otherwise you run the risk of a return of the infection in a more severe form.

[karenbenn]

If I need to take antibiotics, I prefer to take several extra doses then to under-treat the infection.

Edited March 2, 2007 by karenbenn

[Luckydog]

I am about to take some Amoxicillin to clear up a long standing middle ear infection. Anyone have some definitive facts about what is the duration of a complete course of anti-biotics. I have received conflicting advice from several physician and pharmacists in Thailand (surprise surprise!). I was even told yesterday by a doc I thought would know better, to "take for one week but it's ok to stop if the problem clears up before that." Now, where I come from, that is considered anti-biotic mis-use, and can result in bacteria becoming resistant to anti-biotics. All I can find in my net searching so far is about dosage and nothing specific about how long to take the Amoxicillin. Help!

Cheers Rick

The way that they shell out Antibiotics here in LOS is frightening to say the least. I was given three weeks supply of Ciprofloxacin for my Prostate Infection by a Urologist in The Queens Hospital in Sattahip recently. This must not be taken with Zinc Suppliments but did they tell me that? NO. I had to find out on the Internet. Also it has about 20 possible serious side effects. Did they tell me that? Nooooooo. But I shouldn't complain. The previous Doctor wanted to cut my balls off!!!!

[tigerbeer]

<snip>

Amoxil is an antibiotic in the class of drugs called penicillin. It fights bacteria in the body. Amoxil is used to treat many different types of infections, such as tonsillitis, pneumonia, ear infections, bronchitis, urinary tract infections, gonorrhea, and infections of the skin. Amoxil may also be used for other purposes.

<snip>

i had a not so severe tonsillitis and after showing it to the ENT at Chiang Mai Ram hospital, he was sure it was strep bacteria. Prescribed me with 1 Gram Augmentin 2x a day. I felt a lot better after a few days but i have been having a lot of post nasal drips. Its into the 9th day today of having Augmentin and I only have one more day of having it. This morning my tonsils are sore again and slightly painful.

A lot of post nasal drip which I am very prone to but by late morning, its all cleared up. But today, I am worried. Another event of tonsillitis while still being on antibiotics???

I don't know if I should go back to the doctor or just wait and see. What do you guys think?

TB

[Sheryl]

Go back to the ENT. It could just be irritation from post-nasal drip in which case he will prescribe an antihistamine or nasal spray. But if the exam shows that you still ave tionsillitis then insist on a " culture and sensitivity" being done (he swabs the site and they growe it in the lab to see exactly what bacteria is responsible and what antibiotic it will respond to)

[frenchfarangjomtien]

Hi,

Do you know what is the cheapest Amoxicillin in Thailand and what is the best price in drugstores ?

http://en.wikipedia.org/wiki/Amoxicillin

Any website to get a real idea of the medecine price in Thailand ?

Getting bored to be cheated by these millionaire drugstores...

Thanks.

[canuckamuck]

Something I would like to know about antibiotics is when to take them. It seems everything you get here in Thailand is to be taken with a meal, but I am pretty sure I remember that antibiotics work best on an empty stomach. Anyone know the truth?

[FBN]

For an antibiotic to work, it has to reach the site of infection at high enough concentrations to kill the offending bug. In acute infections a short course of very high doses (usually IV) may be sufficient to kill of the bacteria; obviously depending on the type and sensitivity.

For infections such as as otitis, where the bacteria grow in an area with poor blood supply, longer courses are necessary. Also the choice of antibiotic is important as some achieve high concentrations in soft tissues while others do not. Taking and antibiotic with or without food also depends to some extent on the type of antibiotic. Oral tetracyclines taken with milk won't work; the longer acting tetracyclines such as Doxicycline cause lots of gastric irritation so best 1h before or after food. Read the instructions...

[canuckamuck]

You may have noticed that drugs in Thailand often come with little or no instruction at all, and the one handing you the bag always says take with a meal, indicating to me that they haven't got a clue and think all meds are taken with food.

[FBN]

If no clear instructions, look up the medication in the Thai MIMS; link in "Pinned Topics" above or, simply ask the prescribing physician. In Bumrungrad, I have found that the pharmacist actually do explain, or at least ask, if you know how to take the medication.