Defensive antibiotic use

daveumansky · Oct 11th, 2004, 05:28

Prior to my last trip to India in 2002 I was solemnly warned by several individuals that if I did not take antibiotics while there, as a preventive measure, I would become sick. I did not heed their advice, and sure enough I became quite ill during the trip (the usual recurrent intestinal issues, with some occasional fever). When I returned I required brief hospitalization to rehydrate, and was also prescribed a lovely advanced antibiotic called Metronidazole (Flagyl), to cure me of whatever it was that ailed me.

I am returning to India for the entire month of November. I will be taking the usual precautions, which I am sure will be unavailing. I am contemplating buying Metronidazole when I am in India, as it worked well in the past. Apparently one can purchase antibiotics in India without a prescription.

I was wondering if anyone had any opinions on this course of action. I hate the idea of self-medicating, but I am not thrilled about getting sick again, particularly since my new bride and I will be at feted by her family, and we additionally will be guests at a wedding as well as numerous other festivities!

Kingfisher · Oct 11th, 2004, 06:22

personally, I don't think taking antibiotics as a preventative measure is a very good idea. You probably contracted Giardia, which is a fairly common parasite found in contaminated water world-wide. Once you are aware of the symptoms (a couple of foul explosive diarrhoea dumps in the morning, sometimes accommpanied with bloating and 'rotten egg' burps etc.) then it can be cured quickly, usually with a single course of Flagyl. I've contracted Giardia a couple of times over the years and so keep some Indian-purchased metronidazole for it in my first-aid kit.

Baldy · Oct 11th, 2004, 06:34

Yes, giardia is an organism. Therefore don't think Flagyl is an antibiotic.

Agree with symptoms, abdominal bloating, burps, windy watery stool. If you experience this it will not sort itself. I believe Flagyl is not considered all that safe and that better, more modern drugs are available.

Baldy

Nick-H · Oct 11th, 2004, 06:47

I'd be horrified at the thought of taking 'defensive' antibiotics. For a start, I'd expect it to have a pretty poor effect on the stomach. Metronidazole, IIRC, comes with a 'take with food' warning, becaue it is rough on the tummy.

Taking antibiotics on a dentist's advice, they came with a prescripton for probiotics and vitamins, and the arning that they probably would upset my stomach, especially as I was in India. (as it happens they didn't).

Take the stuff when you need it, but give your immune system a chance! And it will have a better chance without antibiotics screwing up the gut flora.

...All in my humble, unqualified opinion, of course

Nick-H · Oct 11th, 2004, 06:54

Quote:

Originally Posted by Baldy

Yes, giardia is an organism. Therefore don't think Flagyl is an antibiotic.

An antibiotic it is: I had several litres of the stuff intravenously after an operation for an infected cyst in my chest a few years ago. In its guise as Metronidazole it is prescribed also for dentl infections,

edwardseco · Oct 11th, 2004, 07:00

We should be polite on this site but your friends know worse than nothing about medicine. Thank them and sign them up for time share sales presentations..

Baldy · Oct 11th, 2004, 07:11

An antiprotozoal in this case - from a pharm. distributor website:

Metronidazole has been shown to be carcinogenic in mice and rats (see PRECAUTIONS.) Unnecessary use of the drug should be avoided. Its use should be reserved for the conditions described in the INDICATIONS AND USAGE section below.

Nick-H · Oct 11th, 2004, 07:18

Baldy; thanks for the data.

I think edwardseco has hit the nail on the head!

daveumansky · Oct 11th, 2004, 08:14

Actually my symptoms also included mild fever, which kind of came and went in a weird fashion over a period of a few weeks. (Note to myself--pack thermometer!) I had no signficant belches and I was no more bloated than usua.
My malady was never formally diagnosed. I do believe that a parasite was ruled out, if memory serves. I do know that I required two liters of intravenous fluid when I returned. For some reason I was in denial and did not go to the doc while I was there.
Incidentally I am not intoxicated with Metronidazole. If anyone has a better suggestion (as long as we are self-medicating here) re an antibiotic to put in my shaving kit, it would be most appreciated.

daveumansky · Oct 11th, 2004, 08:18

Further searching my memory (which I had apparently blocked out for obvious reasons) I recall now that my doctor had me submit a.... pardon me while I retch... diarhhoea sample, which was duly tested and found lacking in parasites. Thus I do believe giardia was ruled out. Still leaves me wondering why I was sick for approx. one month.

ace · Oct 11th, 2004, 08:54

Metronidazole is the generic name for Flagyl (trade name). It is an antibiotic that kills anaerobic bacteria, and is also used as a antiprotozoal agent.

As for taking prophylactic antibiotics especially for a prolonged duration, in general, it is not recommended as you may encounter side effects of the antibiotic itself. One must be aware of the possibility of getting Clostridium difficile diarrhea, which is antibiotic induced. Flagyl has the lowest chance of causing this and is the drug of choice in fact in treating it, but nearly every antibiotic has been associated with it.

Remember too that you can get diarrhea from a number of causes not just anaerobes and protozoa. Flagyl may not be effective against these. The nurse I saw at the health clinic gave me a script for Cipro (ciprofloxacin) to take as needed if I got sick in India . . . cipro covers mainly gram negative bacteria, and is not particularly good for protozoa.

So, if I were you, I would wash my hands, watch what I eat, and try to have fun . . . don't worry too much about all the rest of it. And if you are truly concerned, why not talk to your doctor before you go?

bijapuri · Oct 11th, 2004, 09:20

When shown my "magic pills, when all else fails," a Medical student in his last year of training at Stanford copmmented that these were the "100.000 mile tuneup" of magic pills. They were of course Metronidazole+Cipro, which are available in India. He also commented that if one takes only one or two and doesn't follow thru with a 4-5 day course, "you're setting yourself up to get really worked."

I keep them handy, and they work quite well for myself and also various newbie friends, but would never consider using them as a prophilactic.
. . . .and my degree is in History, mind you, so my advice is experiential, antecdotal, and has no value on the black market. But as for timeshares, PM me

Yoghurt on a daily basis, called curd, or "dahi" is my prophilactic.

daveumansky · Oct 11th, 2004, 11:01

I just pulled this off the website of the US Centers for Disease Control. Interesting. They suggest bismuth (Pepto Bismal) to PREVENT diarrhea. Never heard of that before:

Is prophylaxis of travelers' diarrhea recommended?

CDC does not recommend antimicrobial drugs to prevent TD. Studies show a decrease in the incidence of TD with use of bismuth subsalicylate and with use of antimicrobial chemoprophylaxis. Several studies show that bismuth subsalicylate taken as either 2 tablets 4 times daily or 2 fluid ounces 4 times daily reduces the incidence of travelers' diarrhea. The mechanism of action appears to be both antibacterial and antisecretory. Use of bismuth subsalicylate should be avoided by persons who are allergic to aspirin, during pregnancy, and by persons taking certain other medications (e.g., anticoagulants, probenecid, or methotrexate). In addition, persons should be informed about potential side effects, in particular about temporary blackening of the tongue and stool, and rarely ringing in the ears. Because of potential adverse side effects, prophylactic bismuth subsalicylate should not be used for more than 3 weeks.

Some antibiotics administered in a once-a-day dose are 90% effective at preventing travelers' diarrhea; however, antibiotics are not recommended as prophylaxis. Routine antimicrobial prophylaxis increases the traveler's risk for adverse reactions and for infections with resistant organisms. Because antimicrobials can increase a traveler 's susceptibility to resistant bacterial pathogens and provide no protection against either viral or parasitic pathogens, they can give travelers a false sense of security. As a result, strict adherence to preventive measures is encouraged, and bismuth subsalicylate should be used as an adjunct if prophylaxis is needed.

agoraphobe · Oct 11th, 2004, 11:15

Does the antibiotic bashing extend to Doxycycline too? I'm on it for 7 long months. So far so good (except for the occassion urge to hurl

)

daveumansky · Oct 11th, 2004, 11:17

The CDC's advice re treatment of TD (travelers diaorhhea) is also interesting.... note that Metronidazole is not recommended. Wish I had listened to my mommy and went to med school.

What treatment measures are effective for travelers' diarrhea?

TD usually is a self-limited disorder and often resolves without specific treatment; however, oral rehydration is often beneficial to replace lost fluids and electrolytes. Clear liquids are routinely recommended for adults. Travelers who develop three or more loose stools in an 8-hour period---especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in stools---may benefit from antimicrobial therapy. Antibiotics usually are given for 3-5 days. Currently, fluoroquinolones are the drugs of choice. Commonly prescribed regimens are 500 mg of ciprofloxacin twice a day or 400 mg of norfloxacin twice a day for 3-5 days. Trimethoprim-sulfamethoxazole and doxycycline are no longer recommended because of the high level of resistance to these agents. Bismuth subsalicylate also may be used as treatment: 1 fluid ounce or 2 262 mg tablets every 30 minutes for up to eight doses in a 24-hour period, which can be repeated on a second day. If diarrhea persists despite therapy, travelers should be evaluated by a doctor and treated for possible parasitic infection.

Oct 11th, 2004, 05:28	#1
daveumansky Member Join Date: Oct 2004 Location: NewYork Posts: 14	Defensive antibiotic use Prior to my last trip to India in 2002 I was solemnly warned by several individuals that if I did not take antibiotics while there, as a preventive measure, I would become sick. I did not heed their advice, and sure enough I became quite ill during the trip (the usual recurrent intestinal issues, with some occasional fever). When I returned I required brief hospitalization to rehydrate, and was also prescribed a lovely advanced antibiotic called Metronidazole (Flagyl), to cure me of whatever it was that ailed me. I am returning to India for the entire month of November. I will be taking the usual precautions, which I am sure will be unavailing. I am contemplating buying Metronidazole when I am in India, as it worked well in the past. Apparently one can purchase antibiotics in India without a prescription. I was wondering if anyone had any opinions on this course of action. I hate the idea of self-medicating, but I am not thrilled about getting sick again, particularly since my new bride and I will be at feted by her family, and we additionally will be guests at a wedding as well as numerous other festivities!

Oct 11th, 2004, 09:20	#12
bijapuri laid traps for troubadours Join Date: Aug 2003 Location: Priustan Posts: 2,598	When shown my "magic pills, when all else fails," a Medical student in his last year of training at Stanford copmmented that these were the "100.000 mile tuneup" of magic pills. They were of course Metronidazole+Cipro, which are available in India. He also commented that if one takes only one or two and doesn't follow thru with a 4-5 day course, "you're setting yourself up to get really worked." I keep them handy, and they work quite well for myself and also various newbie friends, but would never consider using them as a prophilactic. . . . .and my degree is in History, mind you, so my advice is experiential, antecdotal, and has no value on the black market. But as for timeshares, PM me Yoghurt on a daily basis, called curd, or "dahi" is my prophilactic. __________________ Focusing your life solely on making a buck shows a certain poverty of ambition. It asks too little of yourself. Because it's only when you hitch your wagon to something larger than yourself that you realize your true potential. Barack Obama lookit me!!!: http://www.flickr.com/photos/bijapuri/ Utube fuzzy logic: http://youtube.com/profile_videos?user=bijapuri&p =r

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Oct 11th, 2004, 06:22	#2
Kingfisher slow typing member Join Date: Sep 2004 Location: west coast canada Posts: 118	personally, I don't think taking antibiotics as a preventative measure is a very good idea. You probably contracted Giardia, which is a fairly common parasite found in contaminated water world-wide. Once you are aware of the symptoms (a couple of foul explosive diarrhoea dumps in the morning, sometimes accommpanied with bloating and 'rotten egg' burps etc.) then it can be cured quickly, usually with a single course of Flagyl. I've contracted Giardia a couple of times over the years and so keep some Indian-purchased metronidazole for it in my first-aid kit.

Oct 11th, 2004, 06:34	#3
Baldy gotta pee ... Join Date: Sep 2004 Location: Brisbane Posts: 187	Yes, giardia is an organism. Therefore don't think Flagyl is an antibiotic. Agree with symptoms, abdominal bloating, burps, windy watery stool. If you experience this it will not sort itself. I believe Flagyl is not considered all that safe and that better, more modern drugs are available. Baldy

Oct 11th, 2004, 06:47	#4
Nick-H Loud-mouthed, Noisy Bird Join Date: Oct 2004 Location: Chennai, India Posts: 27,692	I'd be horrified at the thought of taking 'defensive' antibiotics. For a start, I'd expect it to have a pretty poor effect on the stomach. Metronidazole, IIRC, comes with a 'take with food' warning, becaue it is rough on the tummy. Taking antibiotics on a dentist's advice, they came with a prescripton for probiotics and vitamins, and the arning that they probably would upset my stomach, especially as I was in India. (as it happens they didn't). Take the stuff when you need it, but give your immune system a chance! And it will have a better chance without antibiotics screwing up the gut flora. ...All in my humble, unqualified opinion, of course

Oct 11th, 2004, 07:00	#6
edwardseco Maha Guru Member Join Date: Sep 2001 Location: Land that shakes and bakes. Posts: 4,142	We should be polite on this site but your friends know worse than nothing about medicine. Thank them and sign them up for time share sales presentations..

Oct 11th, 2004, 07:11	#7
Baldy gotta pee ... Join Date: Sep 2004 Location: Brisbane Posts: 187	An antiprotozoal in this case - from a pharm. distributor website: Metronidazole has been shown to be carcinogenic in mice and rats (see PRECAUTIONS.) Unnecessary use of the drug should be avoided. Its use should be reserved for the conditions described in the INDICATIONS AND USAGE section below.

Oct 11th, 2004, 07:18	#8
Nick-H Loud-mouthed, Noisy Bird Join Date: Oct 2004 Location: Chennai, India Posts: 27,692	Baldy; thanks for the data. I think edwardseco has hit the nail on the head!

Oct 11th, 2004, 08:14	#9
daveumansky Member Join Date: Oct 2004 Location: NewYork Posts: 14	Actually my symptoms also included mild fever, which kind of came and went in a weird fashion over a period of a few weeks. (Note to myself--pack thermometer!) I had no signficant belches and I was no more bloated than usua. My malady was never formally diagnosed. I do believe that a parasite was ruled out, if memory serves. I do know that I required two liters of intravenous fluid when I returned. For some reason I was in denial and did not go to the doc while I was there. Incidentally I am not intoxicated with Metronidazole. If anyone has a better suggestion (as long as we are self-medicating here) re an antibiotic to put in my shaving kit, it would be most appreciated.

Oct 11th, 2004, 08:18	#10
daveumansky Member Join Date: Oct 2004 Location: NewYork Posts: 14	Further searching my memory (which I had apparently blocked out for obvious reasons) I recall now that my doctor had me submit a.... pardon me while I retch... diarhhoea sample, which was duly tested and found lacking in parasites. Thus I do believe giardia was ruled out. Still leaves me wondering why I was sick for approx. one month.

Oct 11th, 2004, 08:54	#11
ace Senior Member Join Date: May 2004 Location: USA Posts: 120	Metronidazole is the generic name for Flagyl (trade name). It is an antibiotic that kills anaerobic bacteria, and is also used as a antiprotozoal agent. As for taking prophylactic antibiotics especially for a prolonged duration, in general, it is not recommended as you may encounter side effects of the antibiotic itself. One must be aware of the possibility of getting Clostridium difficile diarrhea, which is antibiotic induced. Flagyl has the lowest chance of causing this and is the drug of choice in fact in treating it, but nearly every antibiotic has been associated with it. Remember too that you can get diarrhea from a number of causes not just anaerobes and protozoa. Flagyl may not be effective against these. The nurse I saw at the health clinic gave me a script for Cipro (ciprofloxacin) to take as needed if I got sick in India . . . cipro covers mainly gram negative bacteria, and is not particularly good for protozoa. So, if I were you, I would wash my hands, watch what I eat, and try to have fun . . . don't worry too much about all the rest of it. And if you are truly concerned, why not talk to your doctor before you go?

Oct 11th, 2004, 11:01	#13
daveumansky Member Join Date: Oct 2004 Location: NewYork Posts: 14	I just pulled this off the website of the US Centers for Disease Control. Interesting. They suggest bismuth (Pepto Bismal) to PREVENT diarrhea. Never heard of that before: Is prophylaxis of travelers' diarrhea recommended? CDC does not recommend antimicrobial drugs to prevent TD. Studies show a decrease in the incidence of TD with use of bismuth subsalicylate and with use of antimicrobial chemoprophylaxis. Several studies show that bismuth subsalicylate taken as either 2 tablets 4 times daily or 2 fluid ounces 4 times daily reduces the incidence of travelers' diarrhea. The mechanism of action appears to be both antibacterial and antisecretory. Use of bismuth subsalicylate should be avoided by persons who are allergic to aspirin, during pregnancy, and by persons taking certain other medications (e.g., anticoagulants, probenecid, or methotrexate). In addition, persons should be informed about potential side effects, in particular about temporary blackening of the tongue and stool, and rarely ringing in the ears. Because of potential adverse side effects, prophylactic bismuth subsalicylate should not be used for more than 3 weeks. Some antibiotics administered in a once-a-day dose are 90% effective at preventing travelers' diarrhea; however, antibiotics are not recommended as prophylaxis. Routine antimicrobial prophylaxis increases the traveler's risk for adverse reactions and for infections with resistant organisms. Because antimicrobials can increase a traveler 's susceptibility to resistant bacterial pathogens and provide no protection against either viral or parasitic pathogens, they can give travelers a false sense of security. As a result, strict adherence to preventive measures is encouraged, and bismuth subsalicylate should be used as an adjunct if prophylaxis is needed.

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Oct 11th, 2004, 11:15	#14
agoraphobe Member Join Date: Sep 2004 Location: Vancouger, BC Posts: 61	Does the antibiotic bashing extend to Doxycycline too? I'm on it for 7 long months. So far so good (except for the occassion urge to hurl )

Oct 11th, 2004, 11:17	#15
daveumansky Member Join Date: Oct 2004 Location: NewYork Posts: 14	The CDC's advice re treatment of TD (travelers diaorhhea) is also interesting.... note that Metronidazole is not recommended. Wish I had listened to my mommy and went to med school. What treatment measures are effective for travelers' diarrhea? TD usually is a self-limited disorder and often resolves without specific treatment; however, oral rehydration is often beneficial to replace lost fluids and electrolytes. Clear liquids are routinely recommended for adults. Travelers who develop three or more loose stools in an 8-hour period---especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in stools---may benefit from antimicrobial therapy. Antibiotics usually are given for 3-5 days. Currently, fluoroquinolones are the drugs of choice. Commonly prescribed regimens are 500 mg of ciprofloxacin twice a day or 400 mg of norfloxacin twice a day for 3-5 days. Trimethoprim-sulfamethoxazole and doxycycline are no longer recommended because of the high level of resistance to these agents. Bismuth subsalicylate also may be used as treatment: 1 fluid ounce or 2 262 mg tablets every 30 minutes for up to eight doses in a 24-hour period, which can be repeated on a second day. If diarrhea persists despite therapy, travelers should be evaluated by a doctor and treated for possible parasitic infection.