Urgent Care Follies

What is it with antibiotics and steroids for upper respiratory infections at Urgent Care these days? Over-prescribing of antibiotics has been a problem ever since the recognition that uncomplicated upper respiratory infections were almost always viral and would resolve on their own. I like to call the Z-pak (a pre-packaged 5-day course of azithromycin, a macrolide antibiotic) a “Placebo Antibiotic.” It doesn’t help a viral infection, but has relatively few side effects, and the accomplishment of making the patient feel like he’s gotten something for his handsome $15.00 co-pay. Not optimal treatment by any means, but an option for the violently insistent patient you just can’t fight with anymore. Prednisone, on the other hand… Steroids are real medicine; not something to f@ck around with. Even the six-day “dose pack” that doesn’t start high enough and tapers down too quickly to do any good when you really need it can cause significant side effects (elevated blood pressure, blood sugar, trouble sleeping, GI upset, stomach bleeding…) and carries the very real risk of making some kinds of infections worse. (Looking at you, Shingles.) Couple that with the, shall we say, questionable diagnostic acumen I’ve observed in many Urgent Care facilities that deign to send me anything, and I’ve moved through bemused, past concerned, coming up on terrified. If you have a cold, first of all wait a week. Stay home, rest, a...
Source: Musings of a Dinosaur - Category: Primary Care Authors: Tags: Medical Source Type: blogs