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May 25, 2005
Speculation: Cipro overuse?
It appears to be standard practice for westerners travelling to Southeast Asia (and other places, for all I know) to be prescribed Cipro as a "just-in-case" measure, in particular for serious traveller's diarrhea. However, there are two obvious ways this can go wrong:First, a large fraction of travellers get some kind of GI problem. Since you have the Cipro (and it expires relatively quickly), it's tempting to take it just to be sure. (Note that Cipro can of course cause its own GI problems, but people often don't know this). Of course, most people don't get bad traveller's diarrhea, so instead of taking the Cipro while on vacation, they just bring it back with them. That's not a problem if it just sits on the shelf, but it's very common for patients to pressure doctors for antibiotics in a futile attempt to cure colds, flu, etc. I wonder how they behave if they happen to have some Cipro lying around.
My friend Kevin suspects that the second form of overuse isn't likely to be much of a problem: sure, people are likely to overuse something like amoxicillin, but Cipro seems high-powered and scary, so he argues that most people won't take it without direct instruction. I'm not so sure. As always, actual data is welcome.
Posted by ekr at May 25, 2005 2:58 PM | Filed under:
Comments
It's not a general practice, fwiw; might be US-specific.
I spent several months travelling through SE Asia a few years back, and was prescribed amoxicillin rather than ciproflaxin by the tropical medicine clinic I visited beforehand in Ireland.
ps: I think you dropped a footnote?
Posted by: Justin Mason at May 25, 2005 3:14 PM
Cipro is nasty stuff. I'm on the tail end of a 14-day regimen for a combination severe sinus infection/pneumonia, and I've been kind of out of it since I started. I look forward to stopping in a couple of days so that I can concentrate again.
From what I can tell, right now, Cipro is dirt cheap in the U.S. The 28 pills that I got would have apparently cost somewhere in the $15 to $20 range without insurance. I'm guessing that there was a huge ramp up in production during the whole anthrax news cycle, and now we have massive stockpiles that will be expiring soon. I think we'll all be better off when it does, since the list of potential side effects is truly nasty. (Ligament ruptures requiring surgery and multi-year recovery periods? Hypersensitivity to ultraviolet light? Random psychoactve effects? No, but thank you for offering.)
If I ever have this combination of infections again, I'm pushing for Zithromax.
Posted by: Adam Roach at May 25, 2005 5:02 PM
Yeah.
A month ago I had an infected tooth and my dentist prescribed amox, which didn't work well, and then zithromax, which did. The once a day for 5 day dosing is also very convenient.
Posted by: ekr at May 25, 2005 7:19 PM