Yeah, don’t. I went to the doctor two months ago thinking I had a raging bladder infection (I get them frequently, and they’re often accompanied by a fair amount of belly pain), and planning to ask for antibiotics. Several hours later, a surgeon was removing my appendix, which was apparently teetering on the edge of perforation. I could have really, really, really, made myself ill.
They aren’t “the one thing”. There are tens of thousands of drugs approved by the FDA, and only a miniscule proportion of them are deemed safe enough for self-prescription. There are aisles and aisles of OTC meds, but most of them are competing brands or formulas combining the same three dozen actual medications in different ways.
Why does the FDA approve *anything *OTC? Honest answer…because most of them don’t work well enough to present a risk. Cold and cough remedies are crap. NSAIDS are moderately effective, but not really at the doses in OTC Advil. OTC sleep aids are…well, if you take them with a nice warm glass of milk while listening to lullabies, then maybe you’ll sleep. The antihistamines are something of an exception; those do seem to work fairly well without causing a lot of trouble.
Generally, if anything is powerful enough to actually work (see, for example: PPA) it’s powerful enough to cause significant health risks and it gets yanked from OTC status, if not removed from the market entirely.
I’m against this, by the way. I think if people want to take the risks of medication side effects or adverse events, they should totally be able to. But the biggest risk with antibiotics is the one that affects the rest of us: the antibiotic resistance. Want to take amphetamines to lose weight and risk blowing out your heart? Fine by me; I can’t catch cardiomyopathy. But if you take the wrong antibiotic for your infection, or you don’t take all of it, I *can *catch your multiple antibiotic drug resistant tuberculosis.
Have you considered reading this thread at all? It’s been answered several times already.
Here’s yet another reason: there are a large number of antibiotics, each of which is only effective against some types of bacteria and not against others. While amoxicillin is pretty wide-spectrum, the only way to know what kind of bacterial infection you have, and thus which antibiotic will be effective, is to get a lab test from your doctor.
Pretty much all of these type of sleep aids have worked well for me. Especially melatonin, possibly the most effective of all, which is extremely cheap and can be bought anywhere. And if one of them won’t do it, a combination of them definitely will.
And that, ladies and gentlemen, is why prescription drugs are regulated to behind the counter.
I was prescribed albuterol once ages ago, and forgot the inhaler at an event. A friend tossed me his Primatene inhaler, took a puff, and immediately wished I hadn’t. Harsh stuff.
Anyway, Primatene inhalers won’t be available much longer-- after Dec. 31, they’ll be off the market due to using CFCs.
Quoth lazybratsche:
Is this possibly indicative of contamination of the soil from antibiotics used in the lab? In other words, would they have gotten the same result if they’d collected the soil sample from across town?
I don’t know the case referred to here, obviously, but the result isn’t surprising. IIRC, all but one antibiotic we have are derivatives of compounds found in nature, i.e. penicillin from bread mold. Antibiotics have been around for a long long time, though far less potent and far less common than after we started mass-producing them. There have always been microorganisms that survived by killing bacterial competition, and for nearly as long, the bacteria have been evolving resistance to their compounds. So I wouldn’t be surprised to find a few resistant strains out in the wild.
Um, aren’t antibiotics used by the pallet-load in Western animal husbandry? Per Al Bundy, if you can get antibiotics for fish w/o an Rx, why is it such anathema for them to be available for people? (Aside, I’d love to be able to find a source for them for my dog. It irritates me to no end to have to get a vet’s say-so—which isn’t free—in order to get the same antibiotic for the same damned UTI she’s gotten from time to time for the last 5 years…)
Now then, if you did self-medicate, I don’t want to see any whining from you when you cook your liver due to a drug interaction, because you didn’t bother looking up your meds in a PDR or other resource. And if you kill yourself because you cleverly tried to end a Gram-positive infection with an antibiotic that only works on Gram-negative critters, or you misdiagnose yourself like Stuff Like That There, I have no sympathy. (Well, I have sympathy, but I don’t think you should prevail in a cause of action against the drug manufacturer)/Rant
As far as the fostering of antibiotic resistance, it seems that such resistance is a commons, a la the tragedy of same. While an answer for solving that tragedy is Coasean bargaining, assuming no transaction costs, I’m not sure how you could privatize the commons of antibiotic resistance. And if we’re equating antibiotic resistance worldwide to a commons, then if antibiotics are freely available worldwide, given easy cheap global travel, what Earthly good does it do citizens in the U.S. to suffer restrictions in their use? IOW, why should I not be able to buy a decent antibiotic—amoxicillin let’s say—if the stuff is flowing like water elsewhere in the world? (and here, in feedlots, if my recollection about U.S. agriculture is correct.)
If you want to lock up vancomycin—or whatever the cool kids are using these days on superbugs—or otherwise heavily restrict its use, be my guest. But for globally available antibiotics, the genie is out of the bottle.
'Cause if the pet owner screws up and the fish dies, nobody cares?
I thought lazybratsche addressed this issue very well in his (her?) very educational post above, but of course you’re going to go on thinking whatever you want to think.
I take a more balanced view than many of the posters. I already know whether I’m allergic to penicillin or not! (And the only reason a prescribing physician would know is because he asks me.) I recall being in a household where everyone had strep throat and I caught it also. I knew it was strep throat because I’ve had many sore throats in my life, strep or otherwise, and the pain sensation with the strep variety is quite distinctive. I paid the $35 to a physician so he could spend 30 seconds looking at my throat just to get permission to pay for a strep test. (The good news was, he said “Red as it gets; it’s strep; I’ll save you the price of the test.” Thank you Doc. And, BTW, I already knew it was strep.)
At least I understand the argument about antibiotics. What about nitroglycerin? Does it have any recreational use? :dubious: Has anyone calculated how many 5mg sublingual tabs it would take to build a bomb? :smack: )
When we were out-of-town on vacation, my mother had her purse stolen and lost her nitros. I ran to a pharmacy and asked for a few pills in case of emergency. They looked at me like I was asking them to break a federal law. (I suppose I was.)
These days I keep nitros (Isordil) on hand for myself. Nitros are over-the-counter in Thailand, but only the biggest pharmacies carry them so I went to the local public hospital when I ran out. Policy there is that doctor’s visit is required for every medicine, prescription or not. But because the doctors were very busy that day the pharmacist sold me a few nitros without waiting for doctor. Seemed like an example of personal initiative and practical commonsense. I might fall over in surprise if I saw something like that in the “Land of the Free.”
What would happen if you smacked a tab with a hammer? That might be amusing. Or not.
And that’s great, but you’re an intelligent, literate, well educated person. Most people aren’t.
And do you know what other medications your penicillin allergy makes you contraindicated for? I mean, I know you can look it up, but again - intelligent, literate and well-educated. I’m not really all that worried about you personally. I’m worried about the kanicbirds of the country, who think it’s a good idea to take a partial regimen and save some for later. Or who don’t know and don’t think to look up carbapenems because they think if they avoid everything that ends in -illin, they’re safe.
I mean, I have diabetic patients who honestly don’t know why they’re taking insulin. People can be astonishingly ignorant and incurious about their meds.
Not that I’m aware of. But it can tank your blood pressure fast. Again, it’s a risk/benefit thing. If you have a cardiac history, then taking nitro when you have chest pain is worth the risk. Even then, we’re supposed to teach you to take your blood pressure first and not take nitro if your BP is too low. That’s exactly the kind of patient teaching that we can’t do effectively if we make it OTC.
Several times, in the US, my SO has been given a few days of his heart meds when the pharmacist couldn’t get through to the Doctor’s office to refill his 'scrip. So while I’m not sure of the exact details, pharmacists are allowed *some *leeway in giving out meds without a current valid prescription. Or the pharmacist just didn’t value his job or license. 
Yeah, they have leeway to continue an existing course of therapy if it has been established and it’s not a controlled substance. The rationale is thatit is in the interests of patient safety to maintain the therapy when the MD is likely to renew the order if it is a maintenance medication.
I’m really having trouble understanding why this is such a difficult concept for most people to get. Drugs are prescription only because they require diagnostics to determine if they are necessary, can potentially interact with other meds, or have a potential for abuse or misuse. PPIs can be OTC because it doesn’t take a doctor to diagnose acid reflux, enough nights of heartburn will tell you that. Same with allergy medication, NSAIDS, or simple topical antifungals It probably won’t hurt you much if you take it and don’t need it, and doesn’t pose much risk to you or to other people. Antibiotics, as it has been demonstrated, pose a risk for individual antibiotic resistance as well as the risk of creating more antibiotic resistant strains of bacteria, which has already happened. Getting antibiotics for your dog or your fish is not the same as millions of people suddenly self diagnosing every cold as a bacterial infection. And the continued use of antibiotics in cattle is also contributing to the problem, so I fail to see how anyone would continue advocating for the free availability of antibiotics when we are already seeing the negative effects of their prolonged use.
As was mentioned upthread, antibiotic resistant bacteria tend to get out-competed pretty quickly if there aren’t any antibiotics to give them an edge: resistant strains that get imported here don’t flourish because they aren’t reproducing in an antibiotic rich environment. This is why the antibiotic resistant strains we do have tend to be in places with lots of antibiotics–hospitals and other institutions.
And for bonus points, can you take Amoxicillin safely? (No looking it up.)
True, but my tail rot is completely gone and I’ve never had a case of ick!
CMC fnord!
No mention of all the dumb folks who think every common cold caused runny nose will respond to antibiotics?
For some reason, I’m remembering back in the 1980s over here, a trip down to the southern islands with some fellow Americans. One – not me, honest! – got roaring drunk one night and had a humongous hangover the next morning. We had to keep moving, so we make it to the ferry transport that will take us out to this one particular island. He falls asleep on deck right out in the sun. He’d been so sick that no one wanted to wake him, but by the time we get to the island, he’s still hung over and he has a ferocious sunburn. Poor guy is suffering badly. He heads to the nearest health clinic, and what do they give him for his hangover and sunburn? Antibiotics!
Which was really, really stupid since many antibiotics increase sun sensitivity and make sunburns more likely. But it does point out how antibiotics, the penicillins especially, have been used almost as placebos.
I think most people in general and many posters in this thread don’t grok just how dangerous the situation with antibiotic resistance is and how close were are to squandering one of the greatest miracles of medicine that humans ever developed.
I realize that sounds like pure hyperbole, but it is not. Almost everyone today has always lived in a world where antibiotics are widely available and highly effective. This is a very recent state of affairs. We forget that just a generation or two ago, this was not true. My grandparents (all now sadly passed) lived until their 30s without access to any antibiotics and my parents were born before antibiotics. In that time, routine minor wounds could be deadly and childbirth was a regular cause of death, to say nothing of community-acquired bacterial diseases.
Misuse of antibiotics is rendering many of the early antibiotics useless and even entire classes are threatened with obsolescence. Even worse, we have forced the evolution of organisms that can resist every antibiotic we have available.
Consider Klebsiella pneumoniae, a normal member of the bacteria on our skin, in our mouths and in our intestines. It is also one of the most common causes of pneumonia and one of the most important hospital-acquired infections. Over the years, K. pneumoniae has become resistant to almost all classes of antibiotics, and the only drugs available were the so-called “drugs of last resort” called carbapenems.
In the Summer of 2008, however, researchers in England and Scandinavia discovered a patient infected with a strain of K. pneumoniae that resisted these drugs. He wasn’t an single freak case, either. Since then more than 180 cases of this strain, called the NDM-1 strain, have been identified in just a few study populations. Where did NDM-1 arise? India and Pakistan - areas where antibiotics are available without prescriptions and misused widely.
To re-iterate: there are no drugs in the pipeline that can bypass the NDM-1’s resistance and K. pneumoniae is a common bacteria. Think that this isn’t likely to affect you? Think again. Gram-negative bacteria like K. pneumoniae swap genes prolifically. We don’t have to wait for NDM-1 populations to out-compete non-NDM-1 strains. “Normal” strains can pick up the NDM-1 resistance gene just by bacterial sex with resistant strains. This spreads the resistance much, much faster. Populations of cells will become resistant without ever having to be exposed to the drug in question.
Even scarier, gram-negative bacteria will swap genes across species. Other gram-negative bacteria you may have heard of include the organisms that cause salmonella, Legionnaire’s disease, stomach ulcers, and gonorrhea. That’s not to even mention that all-time favorite and every single human being’s constant companion, Escherichia coli. How many of these will pick up the NDM-1 gene? That’s impossible to say, but such transfer is a virtual certainty.
In fact the close proximity of E. coli and K. pneumoniae in everyone’s gut has already apparently caused this to happen. A patient in Hong Kong was discovered at an outpatient clinic carrying NDM-1 E. coli without ever having been in a hospital where NDM-1 K. pneumoniae was known to exist. He acquired the NDM-1 infection “in the wild.”
This is just one essentially untreatable bacteria. MRSA and VRE and KPC and others continue their spread across the globe with very few barriers. Proper prescription practices and other public health measures are one of those barriers. Still think worries about antibiotic resistance are a bit overblown, maybe?