[x SF med]

Originally Posted by Trapper John

One afterthought to your question xSF Med - the answer to your question may lie in economics and not medicine. Current healthcare economics demand less hospital time. The thinking, therefor, may be "I will give this ID patient the big gun and get him/her out sooner thus reducing the hospital time and therefore the cost."

Short term thinking. Second and third order effects are the patient needs to be re-admitted and now may have a drug resistant infection. Payers refusal to pay for re-admissions may turn that logic around though.

I can see a similar rationale playing out in outpatient clinics as well.

Just a thought.

Are the docs not thinking of long term toxicity and organ damage with some of these ABX tx's? A short term stay now and more expensive long term care in the future? some of the newer big gun broad spectrum ABX therapies have systemic effects that are delayed by months and years - neuro-muscular, renal, hepatic, hemo, cardiac and pure neuro... and these effects are exascerbated by the compromised immune system and the pathogen itself. I guess I'm old school and still think in the terms of Primum Non Nocere, across the board... harm comes immediately, economically and in quality of life terms, IMOO. YMMV.