Seriously, Ranger, your lack of understanding of what doctors actually do every day is really hurting your credibility. I second what Bondsman said. In many hospital scenarios, when you are presented with an infection, you assume worst case scenario and prescribe broad spectrum coverage in hopes that something will knock back the infection. When the results come in, you can adjust then, but waiting would be deadly. Doctors run culture and sensitivity EVERY DAY so I don't know where you get the claim that doctors don't care about this. Antibiotic resistance is unfortunate, but not using antibiotics and letting patients die in some effort to preserve antibiotic efficacy is worse! What are you saving it for if you're not willing to use it on sick people?!

Also, having normal ranges IS important because there are slight differences between labs in how values are reported, i.e. a 12 in one lab could actually be a 13 in another. The problem was so bad with PT values, they had to invent the INR!!! And, like Bondsman said, you could waste your time reading through every value and double checking it against what you know (yes, doctors do know what a normal Hct is...), or you could have it highlighted and then go straight to the results that are abnormal. It saves time and reduces error. Is that a bad thing?? Even the best doc could miss a line of text or accidentally trace over to the value above or below the one of interest. It happens. Would you prefer doctors make stupid errors so you can point at them and call them idiots? I am sure patients would rather have these safety margins in place.

Also, doctors choose antibiotics based on the efficacy versus a certain infection, NOT on whether a drug rep told them about it. That would be completely pointless. A lot of antibiotics are generic anyway. Plus, if one could get away with it, a good doc would choose the cheapest drug that still works and doesn't have too many side effects. No one wants to run infusions at $1000 a day if they can help it. I know an Infectious Disease doc, and his antibiotic choice is as follows: efficacy>tolerability>co­st. Notice "drug reps" didn't make the list.

How can you possibly know efficacy without culturing? You are essentially playing the odds that this infection is the same as the last one.

Tell me drug companies don't sponsor conferences in resorts again. I love fairy tales.

Are you serious? Do you not know how antibiotics work or something? For being a microbiologist, you sure don't grasp how doctors use your field at all. I'm pretty sure this explanation is a waste of time, but I've got nothing to do right now so I'll go ahead anyway:

There's more to doctoring than reading C&S reports and prescribing what they say. You know how they say medicine is an art? It's because doctors already have a pretty good idea what's causing an infection before the culture is even sent. They look at the symptoms and they get a picture, plus they have a vast knowledge of what the most likely pathogen is in any age group with any particular condition. They have a good idea what the culture is going to be when they send it, but they send it anyway just to be thorough.

Sensitivities, similarly, are helpful but not necessary. All antibiotics work against a set population of bacteria. If a doctor has an idea what you're infected with, then he has an idea what to treat you with, too. They don't need you to run a lab test to tell them that this gram positive is sensitive to penicillin, for example. They already know that. The only thing sensitivities are useful for is determining if the strain is resistant to most drugs.

If a patient has a bad infection, and the doc suspects it could be, say, VRE, he hits them with a combination of drugs that would LIKELY be efficacious. When the sensitivities come in, he adjusts if necessary.

You act like treating infections is a shot in the dark, but it is definitely not. The doctor has a lot more information than just your culture before the culture is even sent. So stop pretending docs are just fools throwing drugs around and that they couldn't possibly know as much about bacteria as you.

As far as drug companies, they prefer to heavily market drugs that patients will ask for and need every day, like heart meds and anti-depressives. When was the last time you saw a commercial for antibiotics?

janneys2005- thank you for trying , but "Ranger" appears to be a troll

Have doctors prescribed antibiotics for colds?

"All antibiotics work against a set population of bacteria."

Help us out here and tell us what the acronyms MRSA and VRE stand for.

"If a patient has a bad infection, and the doc suspects it could be, say, VRE, he hits them with a combination of drugs that would LIKELY be efficacious. When the sensitivities come in, he adjusts if necessary. "

Now you have hit the oxymoron of medicine; act now to stop a severe infection or wait for the lab results to know what it is and what antibiotic will work. If there is really such a need then the doctor acts and also gets the labs. However, what antibiotic does the doctor choose? Here is the another dilemma. If the doctor always uses the latest super antibiotic for a less than serious infection, then the sooner that antibiotic will not be effective. The hot field in pharmaceutical antibiotics is designer antibiotics based on molecular modeling.

"Antibiotic use promotes development of antibiotic-resistant bacteria. Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply. Repeated and improper uses of antibiotics are primary causes of the increase in drug-resistant bacteria.

While antibiotics should be used to treat bacterial infections, they are not effective against viral infections like the common cold, most sore throats, and the flu. Widespread use of antibiotics promotes the spread of antibiotic resistance. Smart use of antibiotics is the key to controlling the spread of resistance."

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Also explain restricted formularies at both the insurance company level and the hospital level. Hint: use the term package deal.

The thread here is nosocomial disease not antibiotic resistance. You can get antibiotic resistance at home when you take what the doctor prescribed. While that is not good, you are at least not getting an additional surprise package from the hospital.

Every patient brings in a resident population of bacteria some of which may have plasmids which can cause antibiotic resistance as you state. However, what needs to be controlled in hospitals is the source of multi-resistance plasmids which can transmit resistance to pathogens acquired in a hospital as well. You make it sound like resistance is only a random occurence. If that were true there would be no "house" pathogens for a hospital. That is just not true. Unless there was some form of transmission of plasmid or pathogen, there would be no particular bacteria in a hospital. That is the issue; not the mode of any antibiotic resistance. The patient does not care whether the nosocomial disease is antibiotic resistant when they contract it or not. Non-resistant bacteria cause damage too especially in hospital patients.

Then the bacteria are not harmless are they? Solution! Load the patient up with commensals. Nice try. Ever hear of opportunistic organisms like Psuedomonas. Thoses are normally part of

The US is rated something 37th in the world for health care. One of the reasons is the arrogant faith in antibiotics rather than stringent infection control. We are behind such technological advanced countries like Greece, Colombia, Chile, Cyprus, Costa Rica, and Singapore.

We have a choice; improve transmission control or play the new antibiotic game which has a diminishing return on it and high costs.

Maybe you can explain what the PharmFree project is if there is no doctor/pharmaceutical company link.

Frankly, Ranger, I have addressed everything you just threw at me already. Which leads me to believe you either can't comprehend what I have said, or you aren't trying. Either way, it would be a waste of my time to continue trying to educate you on this matter. Have a nice life.

I didn't think you would want to address the PharmFree project which is a med school student initiative to reduce the pharamaceutical company influences over doctors including some of the things I previously listed.

http://www.pharmfree.org/

Nor have you addressed why pharmaceutical companies push their package deal for restricted formularies which means an insurance company must only allow the patients/subscribers to use a particular pharmaceutical companies products even if their is another product which is safer, more effective and cheaper but may be the only major product of another pharmaceutical company. This practice is often disguised because if another multi-product pharamaceutical company offers products which do not compete with the first company they can still be used in the restricted formulary. It may also be disguised by partial packages where a major exclusive drug is paired in the formulary with a high profit drug that is similar to drugs from other pharmaceutical companies.

A restricted formulary is jargon for an insurance company only covering certain approved drugs. Remember, you can always "get" any drug your doctor prescribes. The issue is whether your insurance company will pay for it or you will pay the entire price. This is the moral high road of insurance companies who will tell you that you are never "denied" a drug; they just won't pay for it.