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Category Archives: Antibiotics

Although we are in the midst of another flu season here in Canada, it has been the Ebola virus recently dominating headlines and causing fears around the globe. The World Health Organization (WHO) reports more than 14,400 confirmed or suspected Ebola cases as of Nov. 11, 2014, mainly in the African countries of Guinea, Liberia, and Sierra Leone, thus making it the largest Ebola outbreak ever recorded. The current epidemic has led to over 5,100 deaths and the lack of any vaccine continues to cause fears of a global spread of Ebola. However, a closer look at the details regarding these events should ease nerves and help shift focus back to the greater threat of year’s influenza strain.

In the early stages of infection, it is difficult to differentiate Ebola from the flu as both cause non-specific symptoms such as sudden onset of fever, fatigue, headaches and a sore throat. However, Ebola patients will begin to develop vomiting and diarrhea after 3-6 days and approximately half will also experience hemorrhagic events such as nosebleeds, bloody diarrhea, and bruising typically occurring between 2 to 21 days after initial symptoms appearIt is also important to note that unlike the flu, Ebola is not an airborne virus. Furthermore, Ebola can only be transmitted once symptoms appear while flu patients can spread the virus before and during their illness.

Scientists believe that the first Ebola patient contracted the virus after handling an infected animal, possibly a fruit bat or monkey. Unlike humans, these animals are able to ‘host’ the virus without becoming severely ill. Once a human becomes infected, transmission to other people may occur only through direct contact with blood, secretions or other bodily fluids from an Ebola-infected person. In West Africa, this direct contact occurs during traditional West African funerals that involve washing and touching the deceased as part of the mourning process. This practice is not commonly followed in Canada and would limit the rate of transmission if the virus somehow found its way to North America.

You may have heard speculation that mortality rates for the current Ebola outbreak are as high as 90 percent. Keep in mind that these inflated rates are based on patient care settings that are not as sophisticated as the resources available in Canadian facilities. Insufficient medical care, shortage of supplies and a lack of funding are undoubtedly contributing to the epidemic. Although there is no specific treatment or vaccine currently available for Ebola, our hospitals are able to provide high-quality supportive care which can help boost the patient’s own immune system enough to overcome the virus on its’ own.

Therefore, at least within Canada, there is no reason to fear those with a fever or upset stomach. However, reasonable precautions should be followed if we encounter people with Ebola-like symptoms who have also travelled to West Africa within the past 3 weeks. These patients should seek immediate treatment to ensure they receive the best available treatment as quickly as possible. And, of course, getting a flu shot is an easy, effective way to prevent ‘the other virus’ from spoiling your Holiday season!


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Warts are a common viral skin infection caused by human papilloma viruses.  In general warts on the hands and feet are harmless and most resolve on their own.  However, they can cause embarrassment and some discomfort.  There are a couple of over-the-counter (OTC) remedies that work well to treat these kinds of warts.

Infection with HPV occurs with skin-to-skin contact.  Warts are caused by viruses and are passed from person to person.  A common way of contracting the virus is by walking barefoot in public pools, showers etc.

About 30% of warts clear spontaneously in six months and 65% to 78% clear in two years without any treatment.  However, most people would like to resolve warts more quickly than this.  Salicylic acid is a first line OTC option.  This medicine slowly destroys virus-infected skin and may stimulate the immune response of the person infected through mild irritation, which in turn helps clear the infection.  There are a number of salicylic products available.  They range in concentration from 17% to 40%.  A 40% product should be used for plantar warts.  The use of salicylic acid on facial warts is not recommended because of a potential risk of hypo- and hyperpigmentation (skin discolouration).

There is a bit of a regimen to follow with salicylic acid products.  Before treatment the warts should be soaked in warm water for five minutes.  Then, an emery board or pumice stone should be used to remove dead tissue.  The salicylic acid treatment should then be applied.  Treatment may need to be continued for up to 12 weeks. If the wart causes pain, patients can take acetaminophen or ibuprofen for the discomfort. Examples of OTC salicylic acid wart removal products include Compound W, Dr. Scholl’s Clear away Plantar, and Duofilm Wart Remover.

Cryotherapy (freezing) is another common wart removal treatment. This causes irritation and tissue destruction so that the individual mounts an immune response against the virus.  Doctors typically use liquid nitrogen which freezes tissues to -196ºC.  There are also home cryotherapy systems available.  These contain dimethyl ether and propane (DMEP).  Examples include Dr. Scholl’s Freeze away wart Remover, Or, Compound W Freeze off.  Evidence shows DMEP and liquid nitrogen are fairly similar in efficacy.  After application of cryotherapy a blister is formed under the wart.  The frozen skin and wart falls off after about ten days and reveals newly formed skin underneath.   It is recommended that OTC cryotherapy only be repeated three times usually in ten day intervals.

The use of duct tape as a wart treatment has gained popularity.  By putting duct tape over the wart they think the virus is deprived of oxygen which causes irritation and stimulates the immune response to the virus.  Typical administration involves applying silver duct tape over the wart and removing a week later.  Scrubbing the area with an emery board and leaving it open over night.  Then reapplying duct tape.  Silver duct tape has been shown to be more effective than clear duct tape, possibly because of the adhesive.

There are also a number of prescription products that can be used for warts if OTC treatments are ineffective.  Patients with diabetes should consult their physicians before beginning treatment for their warts.  Also, genital warts must be treated by physicians and are not suitable for treatment with OTC methods.

In general OTC wart treatments are effective, however, it may take several weeks for the wart to be removed.  For proper selection of a treatment method come in and speak to your pharmacist.

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One of the greatest breakthroughs in medicine was the discovery of antibiotics.  Antibiotics have saved more lives than any treatment or other type of medication to date.  When used properly antibiotics can heal individuals, who previous to their discovery, would never have recovered.  However, often antibiotics are used inappropriately and indiscriminately.  This leads to a number of problems.

The first of these is antibiotic resistance.  The bacteria we are trying to eliminate get “smart”. A mutation occurs in the bacteria and they “develop” defenses against the antibiotics.  Picture it like a battle front in your body.  You get infected with a bacteria and then you send an “army” of antibiotics against the bacteria.  If used properly you eliminate all of the bacteria.  However, sometimes not all of the bacteria are eliminated and now that they have been exposed to that type of antibiotic they develop a defense mechanism against it.  This “smart” bacteria can be passed on to another individual or remain in your system.  The bacteria can grow and next time you try to treat the bacteria the antibiotic is no longer effective.   This leaves doctors with fewer antibiotics to treat the same infection.  Eventually “Super Bugs” are created which can’t be treated with the usual antibiotics and the individual can develop an untreatable infection that may be life threatening.

The second problem with overuse of antibiotics are adverse drug reactions.  One in five emergency room visits for adverse drug events are due to antibiotics.  Antibiotics can also cause side effects such as diarrhea and rash.   As well, patients can sometimes develop C. Difficile diarrhea.  This is an extremely perfuse diarrhea which can result in hospitalization.  Some antibiotics can interfere with patient’s medication like warfarin and cause the patient’s INR to fluctuate.  They can affect patient’s blood sugar if they have diabetes, and can cause problems for elderly patients if they aren’t dosed properly for ageing kidneys.

Sometimes it’s difficult to know when an antibiotic should be used, however, statistics show they are not needed for most upper respiratory infections.  The common cold and influenza do not respond to antibiotics.  Less than 10% of acute bronchitis cases are caused by bacteria.  Most middle ear infections also resolve without antibiotics.  Sore throats are usually caused by a virus.  Only 15% to 30% of sore throats in children are cause by bacteria and only 10% of cases are strep throat in adults.  Also, almost all cases of acute bacterial sinusitis resolve without antibiotics.

If your family or emergency physician are reluctant to prescribe an antibiotic it is because they suspect a viral infection that is usually self limiting.  Also it is best not to save antibiotics from dental visits or previous infections.  Firstly, they expire and become less effective over time.  Secondly, what is good for one type of infection is not necessarily what is needed for a different type of infection.  Different bacteria are susceptible to different types of antibiotics.  A chest infection requires a different agent from a urinary tract infection.  If you are using the wrong type of antibiotic you are delaying appropriate treatment and putting yourself at risk for resistance and side effects.  Sometimes it is best for the physician to order blood work or urine cultures to determine the type of antibiotic needed.  This allows them to choose the agent that will best treat your infection.

All this being said there are definite times when antibiotics are needed and patients shouldn’t hesitate to be seen by a physician.  Often we see patients with skin infections caused by bug bites where they have delayed being treated because they didn’t realize they needed an antibiotic.

If you are unsure whether an antibiotic is necessary contact a physician, or your pharmacist.  Follow the directions on your medication and finish all of it as directed.    There is definitely a need for antibiotics but overuse is going to lead to fewer and fewer treatment options.  This will be less of a problem if patients and health care practitioners work together to make good decisions about their medication.