john@ur-tut.UUCP (John Gurian) (03/02/86)
> This is getting off the track of the original posting, but one of my pet > peeves is the fact that penicillin is not available over the counter (or > any effective antibiotic, that I know of). Is this due to pressure from > the A.M.A., to force people to see their doctors, or what? It seems rid- > iculous to have to go to the doctor and pay a small fortune, when you > already know what's wrong with you and what you need to fix it. All the AMA's fault? Sounds a little paranoid to me. Anyway, the reason that penicillin is not available OTC is that, although the therapeutic index is high for PCN (ratio of toxic to therapeutic dose): 1) OK, so you think you know what's wrong with you. Maybe 95% of the time you have an infection with a non-resistant gram+ bug that PCN is effective for. But, if you don't, you run the risk of wiping out your normal flora that is sensitive to PCN. This flora keeps the pathogenic bug in check, and when it's eliminated, the bad bug goes crazy and wipes YOU out. Also, you always need to be cultured before going on an antibiotic - infections should not be treated blindly, if possible, and your MD can then, hopefully, prescribe the antibiotic that is most effective. Infectious disease therapy is incredibly complex, with an overwhelming number of drugs to choose from - that's why it's a separate medical subspecialty. That's also why most docs have you get back in touch after 2-3 days of therapy if you're not getting any better. If PCN were legalized OTC, many parents would say, "Oh, my kid's just got a touch of meningitis - I'll get out the PCN", and the kid would be dead within a day. Or, mild, improperly treated infection spreads into a serious, life-threatening infection. What I'm trying to say, in too many words, is that the consequences of your NOT knowing what is wrong with you and how to fix it, and thinking that you do, are very severe, i.e., the cost/benefit ratio, in public health terms, of making PCN OTC is poor. 2) Just as importantly, when people start popping antibiotics the way they pop Vitamin C, you start selecting out resistant strains of bacteria in your normal flora. Which may be OK for you, but not OK for your grandmother, who picks up the resistant strain and then boxes. Again, in terms of public health, it's not a good idea to have tons of antibiotic-resistant strains in the population. We all have them, but they are kept in check by the resistant normal flora of our bodies. This is why you try to treat an infection with the narrowest-spectrum antibiotic that the bug is sensitive to. I should say, one instance where it's impractical to culture first is with a child's middle ear infection, which would require popping open the eardrum. In this case, you go with the drug that will cover the organisms epidemiologically shown to cause infection in most cases (usually Amoxicillin, in this case). If it doesn't get better in 2 days, you need to switch drugs. Incidentally, taking PCN first, and going to a doctor when things don't get better, could mask the infection from culture, making it impossible to know what's growing in you. You may just consider this establishment ravings, but antibiotics are NOT meant to be eaten like candy. -- -- John Gurian -- !rochester!ur-tut!john