Resolved, antibiotics are effective against viruses

Link here: https://www.wkbn.com/news/coronavirus/what-is-regenerons-antibody-cocktail-heres-what-we-know-about-trumps-treatment/

Do I need to link that COVID-19 is a virus, the very thing we have been told not to take antibiotics for?

Many of us have experienced a lessening of symptoms with a viral infection when we were give antibiotics. Many of us were told it was either a placebo effect, or just the normal duration of the infection which had nothing to do with the antibiotics , and many have been told that such use of antibiotics not only didn’t’ work but could cause bacteria to become more resistant to antibiotics with use. I don’t doubt that last one, but give that the president was given a antibiotic for a known virus it does call in question if antibiotics are or are not effective against viruses. Also considering that general antibiotic use in the population may cause bacterial infections to become harder to treat, are we into the age of outright lying to the common person so only the elite will get it to relieve symptoms.

He got an anti-body treatment, not antibiotics.

I don’t know if there was a typo that you are quoting from an earlier version of that article, but both the headline and the section you quoted now correctly say “antibody”, not “antibiotic”.

As to your “resolution”, antibiotics act on components of bacterial structure or metabolism that are simply not present in viruses. There may be a placebo effect, it may be that your own immune system is fighting off the viral infection as it almost always does anyway, or there may be a secondary bacterial infection.

That seams to be the case as I still have the page up that says antibiotic, yet my link if I click on it now says antibody.

Here is where they said antibiotic treatment, but perhaps a typo

Nevertheless, I am not aware of any evidence or theory to support the notion that antibiotics are effective at treating viral disease. I must respectfully cast my vote against the resolution.

~Max

I read this entire list of medications that Trump was taking, and a few of them - zinc and famotidine are the two I remember- were components of some of the hydroxychloquine plus protocols that were being touted back in April.

I know Hydroxychloroquine wasn’t on the list of Trump meds, but maybe the publicly released list wasn’t complete.

Now that we’ve gotten the antibiotics / antibodies type straightened out …

For somebody of the age and importance of Trump it may well be sensible to use antibiotics as well. Not because they will do anything to slow or prevent COVID, which is implausible, but because with everything else going on in a COVID infection, adding an opportunistic bacterial infection at the same time would be very serious.

Just as some people are given antibiotics before a dental procedure; reducing the potential likelihood of infection may have value in the individual case. And can only have that value if used preventatively, not reactively.

As always, the public health concerns of chronic overuse of antibiotics play when we’re discussing what the industry ought to do for every person, or every cow, in the country. For any given patient, especially a demanding one, what’s done probably doesn’t match the Platonic ideal of One Level of Scientifically Statistically Validated Care for All.

Lots of whiny patients everywhere get antibiotics for rhinovirus every day. It may not be smart public policy, or scientifically sound medical practice. But it is effective customer service and sometimes that’s enough for some medics.

There was a theory that famotidine (Pepsid) might bind to or inhibit SARS-CoV-2 proteases 3CLpro or PLpro, based on anectodes and observation of better mortality for COVID-19 patients on that drug. I'm not sure whether that theory has been disproven yet, it's difficult for a layperson like myself to parse the literature. At least one preprint article appears to claim that it does not bind or inhibit either protease.

But famotidine is an H2 blocker, not an antibiotic. You normally take it for GERD and it is available over-the-counter.

~Max

Jumping on this …

Y’never know what they’re thinking or what they might try anyway. There’s strong evidence of a big inflammatory component (cytokine storm) in at least a subset of COVID patients.

The news is talking about days 7-10 as a time when cases tend to see that inflammation.

There have been some tests of antibiotic therapy to reduce levels of some of these cytokines.

Don’t be surprised if we start hearing about Intravenous Immune Globulin (IVIG), other steroids, or some cancer drugs in the next week or so.

If he doesn’t get better and stay better.

Quoting myself …

I just love it when I make a typo while typing … typo.

Sheesh!

It’s certainly possible for a small molecule to be pharmacologically active in different ways. But that would be unlikely to get us to “antibiotics are effective against…”, but rather something more specific to a particular molecule of family.

It gave at least one of us a harmless chuckle.

Some antibiotics have been found to have some antiviral properties. Others have been found to have anti-inflammatory actions. Azithromycin is one that seems to have both those features, and has been tried on many covid patients, including some of my patients (I didn’t start it, the ID people recommended it). However, the jury is still out.

These are uncertain times as to what will and won’t help. It’ll take years and years to sort it all out.

I seem to remember reading once that it is fairly common to give people with viral infections that affect the lungs antibiotics, because bacterial pneumonia is a very common complication; in fact, IIRC, many flu deaths are actually deaths from bacterial pneumonia that happen because the flu made the person vulnerable to bacterial pneumonia.

Bacterial pneumonia is also a common nosocomial infection, and again, IIRC, as people age, they become more and more vulnerable to nosocomial infections. I’m not sure if that means that there is a protocol, such as, “Everyone over 68 admitted overnight to a hospital as a medical/surgical patient gets 3 days of an antibiotic,” but it would not surprise me.

antibiotics can help prevent secondary bacterial infections due to a primary viral infection. not sure if that may be a reason to give them.

I guess my concern is that only the well to do will be given antibiotics because they do help even if it’s to help prevent a secondary infection but the rest of us will be told that it’s viral and antibiotics will do no good.

To put it in other words, The real reason is that antibiotics do good and do help (even if just helping with secondary infections), but if everyone takes them their benefit will be lost, so only the elite will get them. It is that only the elite will get them that gets me.

I don’t see where class discrimination comes into it. You need a prescription for antibiotics in the U.S. To an extent, people who are facing economic hardship may have trouble finding a doctor to write the prescription.

Even with the possibility of widespread antibiotic resistance, there is no national policy limiting the use of antibiotics, and if there were, you can bet it will be decentralized and based on individual doctors making decisions on medical necessity. But it’s not like doctors are going to say, hey, if you make less than $100k, no antibiotics for you!

If that isn’t enough to put your mind at ease, I’m sure you have strong feelings about the organ wait list…

~Max

Most antibiotics are pretty cheap. I have a number of allergies, so there are very few antibiotics I can take, and I still usually pay only about $7 for an antibiotic prescription. If I could take penicillin, I’d probably pay a lot less than that, though-- penicillin probably costs about $1.50 for a prescription.

If someone is sick enough to merit antibiotics, they will probably seek treatment someplace. And they’ll get it, even if it’s at an ER, and they may default on the bill.

Just a little factoid: The CDC estimates that 30% of all antibiotic prescriptions written in the US are unnecessary.

Speaking as a doctor, I’m surprised by that number. Given all the medical reviews I’ve done on physician practice patterns, I’d have said the number was more like 70%.

Overprescription, not underprescription of antibiotics is the big problem. Yes, at times they’re not given when in hindsight they should have been. And use of appropriate antibiotics for viral infections is an extremely small subset of all viral infections. Over 99% of symptomatic viral infections do NOT need antibiotics.

One good reason not to give antibiotics for viral infections is the risk of serious side effects or potentially horrific complications like pseudomembranous colitis, which can result in having to have a colectomy, or death.

Trying to prevent all secondary bacterial infections in patients with viral infections by giving prophylactic antibiotics can cause worse problems than the ones you’re trying to prevent, not the least of which is selecting for antibiotic-resistant microbial strains that may be difficult or impossible to treat.