Right after the stomach bug made its way through the household (as described in The Circle of Bleccccccch), my wife came down with lower abdominal pain, suspicious for a UTI.
(It's okay, I've received the necessary clearance to discuss this with you.)
So I brought home a urine dipstick from the office, confirmed (+) leukocytes, and wrote her a prescription for ciprofloxacin for 3 days.
Five days later, she was having back pain. Seems like the UTI bug fought the cipro and won, and was now moving on to the kidneys.
I consulted my Sanford Guide, wrote a new prescription for bigger, badder Levaquin x 7d, and soon enough, we were good again.
Last night, as the Levaquin started clearing her system, the back pain returned.
We called her OB-GYN, who recommended a repeat urinalysis, this time with culture, as well as a renal ultrasound.
(I suppose we could talk about the ethics of treating family members, but I think my treatment to this point was very standard-of-care. One of the unwritten perks of marrying a primary care physician is easy access to treatment and prescriptions, at least for (apparently) straightforward issues.)
The renal ultrasound was normal. (Levaquin: $25. Renal ultrasound: $694. Peace of mind: priceless.)
Meanwhile, the OB-GYN heard from her partner, who had been talking with a local urologist, who described the exact same thing in 3 other patients recently. UTIs that failed to respond to cipro, followed by Levaquin, finally cured with Augmentin.
The Sanford Guide notes "increasing resistance of E. coli to both TMP-SMX [aka Bactrim] & FQs [fluoroquinolones such as cipro and Levaquin] a concern." We should know in a couple of days exactly what the bug is, and its antibiotic sensitivities, but we are seeing the evolution of antibiotic resistance in almost real-time. The standard, first-line antibiotics are no longer working, and we have to resort to stronger and/or more unusual treatments.
In a similar manner, skin infections such as boils and abscesses used to be treated with Augmentin or first-generation cephalosporins such as Keflex or Duricef. The bug that commonly causes these infections is known as staphylococcus aureus, or staph aureus, or staph. Within the past 3-4 years a particularly hardy variety of staph has emerged, known as MRSA (methicillin-resistant staph aureus). It laughs at Augmentin. It eats Keflex for breakfast. Pediatricians are now being advised to use Bactrim as the new first-line therapy against MRSA, and there are only about 3 or 4 other antibiotics total that have any effect. In some parts of the country, about 20% of the staph is now MRSA. In other places, it is 50%.
I don't get a bacterial culture of every skin infection that I see. However, I can say this: in my area of South Mississippi, over the past two years, every single abscess culture has been MRSA. 100%. Without exception.
And people wonder why I am stingy with my antibiotics.