# Why aren't antibiotics available only by injection? **URL:** \ **Category:** Factual Questions\ **Created:** [September 22, 2009, 8:26pm UTC](https://boards.straightdope.com/t/why-arent-antibiotics-available-only-by-injection/511133 "2009-09-22T20:26:02Z")\ **Posts on this page:** 13\ **Page:** 3
**Author:** ![running\_coach](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/running_coach/32/15836_2.png) [@running\_coach](https://boards.straightdope.com/u/running_coach)\ **Post date:** [September 23, 2009, 7:34pm UTC](https://boards.straightdope.com/t/why-arent-antibiotics-available-only-by-injection/511133/41 "2009-09-23T19:34:53Z")
> [@Qadgop\_the\_Mercotan](#): > > Oh, I don’t know. **They smell better than both perirectal abscesses and pilonidal cysts**. And a chance to cut them is a chance to cure them! Antibiotics aren’t really even necessary for most uncomplicated MRSA soft tissue abscesses. Just drain the damn things and the patient gets better. > > Of course the patients demand antibiotics, and threaten to sue if you don’t give them. Do you often sit around comparing the smell of superfluous, odoriferous orifices?😃 ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [September 23, 2009, 7:50pm UTC](https://boards.straightdope.com/t/why-arent-antibiotics-available-only-by-injection/511133/42 "2009-09-23T19:50:37Z")
> [@Hirka\_T\_Bawa](#): > > With your patients I’m surprised they don’t demand hydrocodone or oxycodone instead! That too. Heck, I had one patient who sued me for killing his tumor, depriving him of its companionship. ---
**Author:** ![rivulus](https://avatars.discourse-cdn.com/v4/letter/r/839c29/32.png) [@rivulus](https://boards.straightdope.com/u/rivulus)\ **Post date:** [September 23, 2009, 8:30pm UTC](https://boards.straightdope.com/t/why-arent-antibiotics-available-only-by-injection/511133/43 "2009-09-23T20:30:40Z")
> [@Hirka\_T\_Bawa](#): > > The rectal route of administration is one of the fastest routes into the blood stream, plus it has the advantage of bypassing first pass metabolism by the liver. The fastest by far is IV, then you have sub-lingual and rectal. > > As you said, rectal is the least liked route of administration, in fact since most people don’t like it, the only major systemic drugs given by the route is ones for little babies, and anti-nausea medication. However pharmacists can compound many other drugs into suppositories if desired. I’ll bet most people don’t know that about the speed of suppositories. Heck, I would seriously consider stuffing something up my ass if I knew it would take away the pain _really fast_ compared to popping some pills. Fighting ignorance, and all that. ---
**Author:** ![Hirka\_T\_Bawa](https://avatars.discourse-cdn.com/v4/letter/h/db5fbb/32.png) [@Hirka\_T\_Bawa](https://boards.straightdope.com/u/Hirka_T_Bawa)\ **Post date:** [September 23, 2009, 9:00pm UTC](https://boards.straightdope.com/t/why-arent-antibiotics-available-only-by-injection/511133/44 "2009-09-23T21:00:23Z")
> [@rivulus](#): > > I’ll bet most people don’t know that about the speed of suppositories. Heck, I would seriously consider stuffing something up my ass if I knew it would take away the pain _really fast_ compared to popping some pills. Fighting ignorance, and all that. Even though it is one of the fastest, the convenience isn’t that great… Specially if you are in public. If you are just looking for an analgesic that is fast acting, your best bet would probably be a liquid formulation, suspension, syrup, etc. Normally they are in children’s strength, but that just means you might have to take more (ask your pharmacist what the correct amount to take for your height/weight). Actually, Tylenol extra strength comes in a suspension now. ---
**Author:** ![Chief\_Pedant](https://avatars.discourse-cdn.com/v4/letter/c/a6a055/32.png) [@Chief\_Pedant](https://boards.straightdope.com/u/Chief_Pedant)\ **Post date:** [September 23, 2009, 9:04pm UTC](https://boards.straightdope.com/t/why-arent-antibiotics-available-only-by-injection/511133/45 "2009-09-23T21:04:33Z")
> [@Harmonious\_Discord](#): > > I had rheumatic fever and Sydenham’s Chorea in first grade because I didn’t have antibiotics for a strep throat. I didn’t have permanent heart damage. The Sydenham’s Chorea severely messed up my life for decades. Having a very debilitation neural disease for most of your life because someone thinks people shouldn’t get an antibiotic is bullshit. > > A second cousin had rheumatic fever and heart damage for the same reason. > > Now let’s look at going in for a shot every day for two weeks as a cost to health care. You increase the costs astronomically and the person is more likely to miss doses or stop when they have to go to a clinic everyday to get cured instead of taking their pill at work at lunch. If only it were that simple. The value of treating strep to reduce Acute Rheumatic Fever depends on the prevalence, and right now the prevalence here in the USA is very low. Moreover, it’s been difficult to show that oral treatment is very effective, even in places (New Zealand’s Maoris, e.g.) where prevalence is pretty high.Many of the studies around prophylaxing acute strep are from back in the 50s and were done with injectable penicillin, STILL the gold standard treatment and, as I mentioned earlier, seldom done. See here in Appendix 6 (p 44) for a summary of studies: [http://www.nhf.org.nz/files/Rheumatic%20Fever%20Guideline%203.pdf](http://www.nhf.org.nz/files/Rheumatic%20Fever%20Guideline%203.pdf) And then you find comments like this: _“In fact, a recent large school-based trial in 24 000 children in New Zealand showed no statistical difference in the incidence of rheumatic fever between those who tested positive for streptococcus and received oral penicillin for 10 days and those who tested positive but received no treatment. ‘This was a brutally disappointing result,’ said Dr Nigel Wilson (Green Lane Hospital, Auckland, New Zealand), a pediatric cardiologist who was involved with the trial.”_[http://www.theheart.org/article/746133.do](http://www.theheart.org/article/746133.do) It’s just never as simple as we make it out to be in medicine. Throw in the fact that maybe 30% of ARF don’t even get an identifiable antecedent strep infection. Here are a handful of reads to get you going, since the issue has affected you personally so much (for which I am deeply sorry): [http://jmm.sgmjournals.org/cgi/reprint/47/8/655.pdf](http://jmm.sgmjournals.org/cgi/reprint/47/8/655.pdf) [http://gsbs.utmb.edu/microbook/ch013.htm](http://gsbs.utmb.edu/microbook/ch013.htm) > **[School-Based Prevention of Acute Rheumatic Fever: A Group... : The Pediatric...](https://journals.lww.com/pidj/Abstract/2009/09000/School_Based_Prevention_of_Acute_Rheumatic_Fever_.7.aspx)** > > ly supported. The efficacy of injectable penicillin, in high rheumatic fever incidence military environments is indisputable. > > Objective: > > To evaluate school-based control of rheumatic fever in an endemic area. > > Methods: > > Fifty-three schools... ---
**Author:** ![Chief\_Pedant](https://avatars.discourse-cdn.com/v4/letter/c/a6a055/32.png) [@Chief\_Pedant](https://boards.straightdope.com/u/Chief_Pedant)\ **Post date:** [September 23, 2009, 9:12pm UTC](https://boards.straightdope.com/t/why-arent-antibiotics-available-only-by-injection/511133/46 "2009-09-23T21:12:13Z")
> [@HorseloverFat](#): > > I completely disagree. After seeing two people close to me get MRSA in the last two years and hearing stuff like “well, if this doesnt do it, then you might be in trouble” along with reading the mortality rates involved.. well, its fucking scary. > > As far as science keeping up goes, my understanding is that we’re pretty close to the end of our rope here and all the big breakthroughs early in the 20th century were the low hanging fruits of antibiotic science. We just arent going to have another period with so many new substances because they probably dont exist. Again, the issue is not whether methicillin-resistant staph is serious, but whether antibiotic resistance is a new problem or an old problem, and whether or not we are keeping up. It certainly is a cause du jour, but this old geezer has seen those come and go, day by day. As a rule of thumb, those who check out from assorted multiply-resistant strains are those whose immune systems are compromised in some way. Cold comfort, but certainly not a new problem. As far as medical science being at the end of its rope, I beg to differ, but we’ll have to come back in a few years to see who was right. We are only just beginning to figure out molecular-level medicine. I’m betting on science. “Science Reaches End of Rope” is great copy writing, but hardly accurate. It may sell newspapers but it’s nothing more than a polloi-scaring headline, IMHO, and of little substance. ---
**Author:** ![ToeJam](https://avatars.discourse-cdn.com/v4/letter/t/dfb087/32.png) [@ToeJam](https://boards.straightdope.com/u/ToeJam)\ **Post date:** [September 23, 2009, 9:13pm UTC](https://boards.straightdope.com/t/why-arent-antibiotics-available-only-by-injection/511133/47 "2009-09-23T21:13:06Z")
> [@Qadgop\_the\_Mercotan](#): > > That too. > > Heck, I had one patient who sued me for killing his tumor, depriving him of its companionship. :eek: That… makes up for all the lost Qadgop stories that you never get to tell us anymore. Wow. That’s just Awesome. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [September 23, 2009, 9:48pm UTC](https://boards.straightdope.com/t/why-arent-antibiotics-available-only-by-injection/511133/48 "2009-09-23T21:48:37Z")
> [@Ro0sh](#): > > :eek: > > That… makes up for all the lost Qadgop stories that you never get to tell us anymore. > > Wow. > That’s just Awesome. The patient represented himself, and his complaint, filed with the court, was a little bit less than coherent. It didn’t go far. But it does count as a lawsuit against me for reporting purposes. ---
**Author:** ![ToeJam](https://avatars.discourse-cdn.com/v4/letter/t/dfb087/32.png) [@ToeJam](https://boards.straightdope.com/u/ToeJam)\ **Post date:** [September 24, 2009, 12:05am UTC](https://boards.straightdope.com/t/why-arent-antibiotics-available-only-by-injection/511133/49 "2009-09-24T00:05:59Z")
> [@Qadgop\_the\_Mercotan](#): > > But it does count as a lawsuit against me for reporting purposes. I’ve always wondered- does that ever really mean anything? The lawsuits against you even if you win them? Because the prison doc I shadow seems to have a few- as does pretty much every other prison docs in the area… ---
**Author:** ![horsetech](https://avatars.discourse-cdn.com/v4/letter/h/dec6dc/32.png) [@horsetech](https://boards.straightdope.com/u/horsetech)\ **Post date:** [September 24, 2009, 12:21am UTC](https://boards.straightdope.com/t/why-arent-antibiotics-available-only-by-injection/511133/50 "2009-09-24T00:21:40Z")
> [@Level3Navigator](#): > > Wow! Has any human ever tried to inject themselves with something like that? I mean, how different is Agri-cillin from the Penicillin my doctor might give me? How would they figure the dosage? And outside of Seinfeld episodes on TV, how often do people try to take animal medicine? The concentration and inactive ingredients might be different from what is used in people, but a lot of veterinary drugs are made by the same companies as the parallel human drugs, just with a different label. Heck, a decent fraction of the prescription drugs used in horses ARE the human drug, as a veterinarian with a license (and DEA number for controlled substances) can legally prescribe any human OR veterinary drug for an animal, provided that it falls within the limits of acceptable/non-negligent practice. I’m sure there are some rugged individualist types who self-medicate with veterinary injectable antibiotics, but I doubt it’s common. I have had a couple people tell me that they have taken oral antibiotics from their barn supply. Also, some show horse trainers/riders from other boards swear by a squirt of Banamine (an anti-inflammatory) in the morning orange juice as a hangover remedy, and there are racetrack trainers who have trashed their livers taking Bute, another horse NSAID that was on the human market briefly but got pulled for dangerous side effects, such as occasionally screwing up your bone marrow and causing it to stop producing important things like platelets and WBC’s. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [September 24, 2009, 12:25am UTC](https://boards.straightdope.com/t/why-arent-antibiotics-available-only-by-injection/511133/51 "2009-09-24T00:25:54Z")
> [@Ro0sh](#): > > I’ve always wondered- does that ever really mean anything? The lawsuits against you even if you win them? Because the prison doc I shadow seems to have a few- as does pretty much every other prison docs in the area… In job or hospital privilege applications for physicians, it’s a standard question: Have you been sued? If so, give details. And any settlements or verdicts against you get reported to the National Practitioner Data Bank. No mention of the actual merits, just the fact that you didn’t clearly win gets listed. I frankly don’t care anymore, but since I spent 15 years in private practice without getting sued, it was an adjustment to get used to being sued 2 or 3 times a year now. ---
**Author:** ![Hirka\_T\_Bawa](https://avatars.discourse-cdn.com/v4/letter/h/db5fbb/32.png) [@Hirka\_T\_Bawa](https://boards.straightdope.com/u/Hirka_T_Bawa)\ **Post date:** [September 24, 2009, 12:31am UTC](https://boards.straightdope.com/t/why-arent-antibiotics-available-only-by-injection/511133/52 "2009-09-24T00:31:40Z")
> [@Qadgop\_the\_Mercotan](#): > > I frankly don’t care anymore, but since I spent 15 years in private practice without getting sued, it was an adjustment to get used to being sued 2 or 3 times a year now. I would love to be on a jury for something like this… But then, I would think the lawyer for the suer would dismiss me for cause… (never been called for jury duty, something I’ve always wanted to do though) ---
**Author:** ![Left\_Hand\_of\_Dorkness](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/left_hand_of_dorkness/32/7156_2.png) [@Left\_Hand\_of\_Dorkness](https://boards.straightdope.com/u/Left_Hand_of_Dorkness)\ **Post date:** [September 24, 2009, 12:48am UTC](https://boards.straightdope.com/t/why-arent-antibiotics-available-only-by-injection/511133/53 "2009-09-24T00:48:25Z")
As a person with a severe (sent me to the emergency room last year) needle phobia, I am desperately glad that antibiotics are available in pill form. On the very rare occasions I go on them, I take every single last freakin one of them in gratitude. [Previous page](https://boards.straightdope.com/t/why-arent-antibiotics-available-only-by-injection/511133.md?page=2)