Can amoxicillin be bought over the counter in a pharmacy."
"This makes all the sense in world," she says.
It may be true that, because of his experience, Dr. Nalbant is a bit more cautious in prescribing amoxicillin than an average doctor.
But that doesn't mean everybody does what he says.
The issue was discussed on American Medical Forum May 30 by Dr. Paul Ziai, chief of emergency medicine at the University of Michigan Health System. After being asked whether it was acceptable to prescribe amoxicillin after hospital discharge to patients without an infection, Dr. Ziai replied,
"I'm not sure about prescribing it to someone who has no symptoms. Ampicillin should be used first for infections occurring in the hospital or long-term care facility."
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He added that would never prescribe penicillin for a person who had not an overnight stay in the hospital and he added, "Most of my staff would agree with that position."
Dr. Ziai told the attendees that he did not know how often amoxicillin was given over the counter and that he didn't want to put a burden on patients to prove him that they had a diagnosis.
"In my practice I don't treat symptoms," he said. "I the underlying diseases. If I feel the patient has a diagnosis of more serious disease, that can be corrected by giving the drug."
In a survey last year by the American Medical Association, which represents all doctors, 63 percent of physicians said they didn't usually prescribe medications on hospital discharge.
Dr. Nalbant says it is a big jump from saying no to giving antibiotics.
"That goes from the position of doctors not to prescribe antibiotics on hospital stay to the position that doctors should prescribe it," Dr. Nalbant says.
One big issue is that antibiotic resistance increasing at a rate that is alarming public health officials.
For example, the latest superbug, carbapenem-resistant Enterobacteriaceae, or CRE, has made it to hospital floors in 23 states. This superbug is now resistant to almost all penicillin, ampicillin and cephalosporins but is resistant to many other antibiotics.
Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, put that problem in perspective when he recently warned that because of antibiotic resistance, one out every seven infections is caused by one drug.
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"This is not a game," Dr. Frieden said. "This is a very real threat to our national health."
In his role as president emeritus of the American Medical Association, Dr. Nalbant says that a committee should develop guidelines to help doctors and hospitals recognize the warning signs.
In the survey, doctors who have practiced for years say they don't consider the warning signs.
One of those is not giving a patient antibiotics when he returns from a business trip or vacation without an illness. Many doctors believe that when antibiotics aren't needed, they are not really needed; Dr. Nalbant suggests that doctors keep a log to make sure they aren't prescribing medications that are ineffective against infections.
Another common practice is to prescribe more medicines than doctors need.
Dr. Nalbant warns that doctors can go overboard with this practice.
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Amoxicillin is a penicillin antibiotic that fights bacteria. Amoxicillin is used to treat many different types of infection caused by bacteria, such as tonsillitis, bronchitis, pneumonia, gonorrhea, and infections of the ear, nose, throat, skin, or urinary tract. Amoxicillin is also sometimes used together with another antibiotic called clarithromycin (Biaxin) to treat stomach ulcers caused by Helicobacter pylori infection. This combination is sometimes used with a stomach acid reducer called lansoprazole (Prevacid). There are many brands and forms of amoxicillin available and not all brands are listed on this leaflet.
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