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Dilemma Doctors encounter due to prolonged Antibiotics Treatments

Doctors are faced with challenges when treating patients who have had prolonged antibiotics treatment for the same identical diagnoses. There are several reasons why antibiotics drugs may no longer respond or cure any of these effects. Most antibiotics are intended to build defense barriers to known bacteria germs, destroying or eradicating their effects on the human anatomy within a period of two weeks to a month.

The human anatomy eventually may form resistance against these sorts of antibiotics which calls for the doctor to prescribe another form of antibiotics or come up with other alternatives depending on how long the patient have being using certain particular antibiotics and how to mitigate, reducing the concentration of bacterium organisms in their patients.

During this period, Calcium might decrease how much antibiotic your body absorbs. Taking calcium along with some antibiotics known as “quinolones” might decrease their effectiveness. To avoid this interaction, take these drugs at least 2 hours before, or 4 to 6 hours after calcium supplements.

Some quinolone antibiotics that might interact with calcium include ciprofloxacin (Cipro), levofloxacin (Levaquin), ofloxacin (Floxin), moxifloxacin (Avelox), gatifloxacin (Tequin), gemifloxacin (Factive), and others.
AVELOX (moxifloxacin) hydrochloride is a synthetic antibacterial agent for oral and intravenous administration. Moxifloxacin, a fluoroquinolone, is available as the monohydrochloride salt of 1-cyclopropyl-7-[(S,S)-2,8diazabicyclo[4.3.0]non-8-yl]-6-fluoro-8-methoxy-1,4-dihydro-4-oxo-3 quinoline carboxylic acid. It is a slightly yellow to yellow crystalline substance with a molecular weight of 437.9. Its empirical formula is C21H24FN3O4*HCl and its chemical structure is as follows:

AVELOX (moxifloxacin hydrochloride) Structural Formula Illustration
AVELOX Tablets
AVELOX Tablets are available as film-coated tablets containing moxifloxacin hydrochloride (equivalent to 400 mg moxifloxacin).
The inactive ingredients are microcrystalline cellulose, lactose monohydrate, croscarmellose sodium, magnesium stearate, hypromellose, titanium dioxide, polyethylene glycol and ferric oxide.
AVELOX Injection

AVELOX Injection for intravenous use is available in ready-to-use 250 mL flexibags as a sterile, preservative free, 0.8% sodium chloride aqueous solution of moxifloxacin hydrochloride (containing 400 mg moxifloxacin) with pH ranging from 4.1 to 4.6. The flexibag is not made with natural rubber latex.
The appearance of the intravenous solution is yellow. The color does not affect, nor is it indicative of, product stability.
The inactive ingredients are sodium chloride, USP, Water for Injection, USP, and may include hydrochloric acid and/or sodium hydroxide for pH adjustment.
AVELOX Injection contains approximately 34.2 mEq (787 mg) of sodium in 250 mL.

During one of my clinical residence rotation, one of the patient cared by team of students I was leading thought this case was unique and had to pay special attention on patient’s recovery. Major steps where taking, during which, intervals of blood and excretion collection for further test and analysis of different cultures were needed. The elimination recommended hospitalization in order to totally eradicate, obliterate and exterminate such infectious endocarditis.

The patient came in very sick, a direct result to risky behavior and admitted for infectious endocarditis secondary to intravenous opioid abuse. The patient had her second heart valve flushed and stabilized eight days prior with the first stabilization done nine months before. The valve stabilization was done at another area hospital, and discharged to a skilled nursing facility for extended antibiotics. Evidently, left the facility and later presented at our emergency department. Blood cultures grew multidrug resistant bacteria, presumably due to injecting opiates through Peripherally Inserted Cutaneous (PIC) line. The catheter that was placed as lifeline was instead functioning as an entry point due to addiction introducing and inflicting intravenous opioid into the body. One week later, the patient was transferred to Intense Critical Care Unit (ICCU) to manage a pericardial effusion turned cardiac tamponade, hypoxic encephalopathy, anuria and septic shock. The patient had slim chances of survival based on the diagnosis of the team. They were skeptical at the beginning and did not expect nor anticipate a full recovery of the patient.

Questions posed by the team were not quite clear, some thought patients should acquire privilege of another valve stabilization, and some surgeons refuse to do repeated valve stabilization knowing chronic addiction is often a fatal illness, with or without a valve stabilization. Going by guidelines to urge for or against such decision could life-or-death situation.

What about the harm that could be done to others? Occupational hazards posed to the surgical team are significant. A needle stick or other breach of host immune defenses could lead to a chronic and dangerous hepatitis C infection, for example. What about effects to society? An uninsured patient in this situation will accrue millions of dollars in medical expenses between the surgeries, management by multiple medical teams, months of inpatient antibiotic therapy (high-risk patients are not usually discharged with a PIC line), social work support and later repeat drug rehabilitation and therapy. The hospital will absorb costs and ultimately pass them on to other patients in the form of increased fees for service.

Furthermore, two Americans die every hour each day from prescription opioid overdoses, 17,000 annually, while 8,200 Americans die annually from heroin overdoses. The number of opioid prescriptions to individuals ages 15 to 29 nearly doubled between 1994 and 2007. Greater than 50 percent of individuals 16 years or older have used prescription pain relievers from a friend or relative for non-medical purposes (per the American Society of Addiction Medicine). Surely we could do more for this population.

The American Medical Association Code of Medical Ethics discusses resource allocation and states, “Non-medical criteria, such as the ability to pay, age, social worth, perceived obstacles to treatment, patient contribution to illness, or past use of resources should not be considered.” While the ethical implications are important to consider in such cases, I chose to focus my energy toward doing what I could to change the patient’s trajectory in a short couple of weeks.



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