I don't think that science says the severity of symptoms is related to the resistance of the germs.
Isn't it related to the quantity of the germs, though? And the goal is getting the population low enough that your own immune system can finish the job?
If you have a mild early infection, then your immune system has not yet started producing antibodies at full speed, because it takes a while to get fully spun up. If you have a raging late-stage infection, then your immune response is already running at full speed (hence the fever, oozing etc). It's quite possible that the same duration of antibiotics might be required in both cases.
That's too simplistic, I think. There are plenty of early, mild infections that your immune system can dispose of on its own, without help. There are others that blow up and overwhelm your immune system.
Isn't it related to the quantity of the germs, though?
No, it's related to the size of the patient. The objective is to convert Rascal into a sufficiently concentrated solution of antibiotic - "sufficient concentration" being "enough of him is antibiotic that every bacterium in him is having trouble". The number of bacteria in him doesn't really matter. If both his ears were infected, you wouldn't give him twice the amount of antibiotic as if only one ear was infected.
Antibiotics are poisons, they're not bullets. If you need to shoot 2x rats, you need 2x bullets. But if you want to gas all the rats in a room, you need enough gas to raise the percentage gas in that room to a lethal level. It doesn't matter how many rats are in there.
It is definitely not the case that each germy cell requires a full ten days to be weakened and killed, and then they all die off en masse on the 10th day. Some die quickly, some keep reproducing, and at some point the antibiotics plus your own immune system has killed enough of them that you start to feel better.
If both his ears were infected, you wouldn't give him twice the amount of antibiotic as if only one ear was infected.
This is because antibiotics are systemic and not topical, and so you're treating the entire patient either way. But if the left ear is twice as infected as the right ear, I would expect that the right ear will feel better sooner, and the infection would be undetectible more quickly on that side.
Antibiotics are poisons, they're not bullets. If you need to shoot 2x rats, you need 2x bullets. But if you want to gas all the rats in a room, you need enough gas to raise the percentage gas in that room to a lethal level. It doesn't matter how many rats are in there.
I don't think the poison analogy works, because rats aren't having baby rats while they're being poisoned, among other problems.
Anyway, I assume there's a probability distribution for successful treatment by number of days treated and they picked days to p less than .05. But taking degree of symptoms into account didn't happen except to set a floor for inclusion in the study.
It's just not worth spending lots of money to figure out who should get 8 days or 10 days or 12 days. There's so many other things that'll be a higher priority for researcher time and money. Once you find a course that basically works and which has been tested you just stick with that.
What ajay says about dosage sounds compelling (but I'm not an expert), but that's about dosage not length of course. Once you hit the right concentration in the body the bacteria are going to be dying off at some rate, and if you have more bacteria surely it'll take longer to get that number down. It has to be some exponential decay function.
It's just not worth spending lots of money to figure out who should get 8 days or 10 days or 12 days. There's so many other things that'll be a higher priority for researcher time and money. Once you find a course that basically works and which has been tested you just stick with that.
I think the first two sentences are very wrong, but the last is correct. There's a huge amount of inertia to update anything in the interface with patient compliance.
Patients are kind of assholes, except compared to doctors.
13: I dunno. Why spend two years of clinical trials working out that actually for an ear infection you only need 7 days of amoxycillin not 10? That's saved you three pills per patient - in the same time you could have been working out a treatment for something that actually didn't have a treatment yet. 10 days is the standard period for clinical trials, so that's what you know is going to be effective and not kill the patient. Going through that whole business again at huge expense just so you can tell people it should be 7 not 10 seems daft. (Even putting aside the fact that the trials are going to be funded by the company that produces the antibiotic, so they don't have much of an incentive to tell people to buy slightly less of their product!)
Once you hit the right concentration in the body the bacteria are going to be dying off at some rate, and if you have more bacteria surely it'll take longer to get that number down.
Not necessarily. Some antibiotics block reproduction rather than killing the bacteria.
Why spend two years of clinical trials working out that actually for an ear infection you only need 7 days of amoxycillin not 10? That's saved you three pills per patient - in the same time you could have been working out a treatment for something that actually didn't have a treatment yet. 10 days is the standard period for clinical trials, so that's what you know is going to be effective and not kill the patient. Going through that whole business again at huge expense just so you can tell people it should be 7 not 10 seems daft.
This seems hugely inconsistent with the microscopic nature of tons of scientific progress, not to mention the fact that such studies exist, as linked above.
I should have said Plan-ti-B-iotics. Goddamnit.
The ones that facilitate reproduction are Panty-biotics.
This seems hugely inconsistent with the microscopic nature of tons of scientific progress, not to mention the fact that such studies exist, as linked above
Yes, and those studies have led to medical associations changing their advice on the appropriate length of treatment courses for antibiotics, as linked above, so the entire premise of your post - "it's always ten days for antibiotics" - is wrong.
I treat my ear infections by putting rubbing alcohol in them with a q tip.
22: Have you considered a more drastic solution?
15.last: Killing and blocking reproduction are basically interchangeable, everything here is exponential growth or decay and all that matters is the constant in the exponent. If you block reproduction then the growth goes away and the body kills them off at some rate, and again that's exponential decay. But everything in sight is f' = c f for various constants c.
So, it's not always ten. It's ten for amoxicillin/ear infections, which is a shit ton of antibiotic prescriptions. But it's five for the antiviral Tamiflu, and a week for something else the kids were prescribed recently, five for Paxlovid.
100% willing to believe that 10 days is based not much more than tradition plus one early study and that 7 or 8 is fine BUT also that part of this is clinical judgment - if five is definitely too short and we know that 80% of people don't finish the course, one might set the bar at 10 over 8 even if the lab says most of the work is done by day 3-5.
I really think the "one early study" likely plays a huge role here. Look at Moderna and Pfizer's covid vaccines, they're basically the same as each other but Moderna is 100 micrograms and Pfizer is 30 micograms, and Moderna has a 4-week gap between the two doses while Pfizer has a 3-week gap. It's just because that's what they decided to do a big test on, and they're not going to redo it! Odds are very high that either one would be fine on the other's dosage and schedule (and either would be slightly more effective on Moderna's schedule), but we're just going to keep doing it differently forever because it's expensive to run the tests again!
They both failed to improve wifi reception even though I heard they would.
But it's five for the antiviral Tamiflu, and a week for something else the kids were prescribed recently, five for Paxlovid.
Not antibiotics, but your point stands. But 10 days is certainly the default for large categories of infections.
Yes, and those studies have led to medical associations changing their advice on the appropriate length of treatment courses for antibiotics, as linked above, so the entire premise of your post - "it's always ten days for antibiotics" - is wrong.
The advice has changed, but the implementation hasn't, in most cases.
I think the proper analogy here is USDA food temperature recommendations. Following them means every last goddamn living thing in your food is dead, taste be damned. They don't do tiered recommendations that include "you're extremely likely to be totally fine."
Yeah, well I think the proper analogy is with cooking in the oven. Cooking time for a little muffin is different from cooking time with a giant loaf of bread, because the heat has more little particles to penetrate.
Actually, the proper analogy has to do with how an adult can read a book much faster than a child. You wouldn't force an adult to take ten days to read a book if they've killed it on the second day, now would you?
No, wait, wait. I've got it. The proper analogy is with train times. It doesn't take all trains the same length of time to go between different starting and ending points. That would be ludicrous. One train might take ten days, but another train might only need one hour because the route and destination is entirely different.
Honestly, I read books over many days now and a child I'd finish adult-level books in a day.
I'm pretty sure it has something to do with how different planets have different length "years" that it takes them to orbit the sun.
It's kind of like how some comment threads last for ten days, and other comment threads don't get ten comments.
Some high holy days last ten days, while other holidays are finished much quicker. Just different levels of inflammation.
Some letters of recommendation take me a really long time to write, because I'm screwing around on Unfogged instead of being productive.
32: heebie, is that really true? Asking seriously. I'd think that the real issue is with the instantaneous energy-input capability of the oven? So a convection oven that could put in many more BTUs per unit time, would cook a whole tray of muffins as fast as a single muffin ? B/c the issue is most quickly getting the air right next to the surface of the muffin (and the surface of the tin) to the desired temp and holding it there ? And that's easier if you just stick a single muffin into the oven, than if you stick a whole tray of them ?
Am I missing something?
And it would seem like this is related to Ajay's analogy for poison gas in a room to kill rats .... bigger room (== "more muffins") needs more gas ? [ok, analogy breaks down, b/c "why isn't bigger room like bigger oven, henghhhh?"]
39: truly, isn't this what ChatGPT is *for* ? "ChatGPT, write me a slightly-ambiguous but still enthusiastic letter of recommendation"
I don't even have a ChatGPT! By the way, the face pull exercises are great.
42: Isn't it open to everyone? Actually I just checked and it turns out -- "ChatGPT is at capacity right now" Darn!
29: right my point was "different lengths for different drugs." It's just that nearly everything kids get gets amoxicillin.
Right, but the OP point is specifically that within a single kind of antibiotic, why not vary the length of the course?
OMG why do I keep finding myself not working on those stupid recommendations. I need to knock them out now.
Try an extended course of antibiotics.
You might think there would be a risk of creating a resistant strain of super-recommendations, but realistically that's already happened.
Also, the recommendations that I'm procrastinating on are for the Barry Goldwater scholarship. And it's one of these irritating things where they're very specific about wanting me to expound about the student's research and career goals and leadership plans and crap like that. How on earth should an undergrad sophomore know their research goals?
I misread 49 as David Cross and was shocked. Phew.
They were both associated with famous musical groups, if you count The Chipmunks.
50: If the students are interested in started a nuclear war or ending Social Security, you could mention that.
45: then my guess is that they tested for safety/efficacy, gave an FDA like range per ogged, and it's amoxicillin, so it just doesn't matter all that much to revisit it. The article linked above had studies done for fairly specific cases (probably where cost of treatment matters more) to revisit the antibiotic usage.
I think the proper analogy here
...
Posted by: ogged
Truly, we live in fallen times.
Barry Goldwater scholarship
Research interest: "Whether to make a world in which all of God's children can live, or to go into the dark. We must either love each other, or we must die."
Interesting question. Some research and review articles on the topic.
Interesting question. Some research and review articles on the topic.
re: 49
AIMHMHB, I came across _If I Could Only Remember My Name_ quite recently, when it was reissued in 2006, even though I'd been familiar with CS&N and CSN&Y since I was a kid.* I was totally blown away by it, and by his voice specifically.
* my parents had a couple of their albums, and, iirc, "Harvest".
There's a quote attributed to Goldwater doing the rounds on the Internet, where he warns quite accurately of the disastrous effects of evangelicals taking over the Republican party. If genuine, good for him. But I still wouldn't let him move in next door or marry my daughter. Not for all the farms in Cuba.
60. But did he do anything since then?
re: 62
There's a couple of well-received recent albums which I've not listened to (lots of critical plaudits, though) and then a massive gap of about 30 years in between where not much at all, other than some backing vocals and the like.
It's possible the talent was in the original liver.
61: If it's the stuff in this 1981 Washington Post article, probably correctly attributed. Though I suspect part of that is just him having come of political age during a trough of evangelical politics; if they had been a force when he had a shot at being president he probably would have opportunistically worked with them just as Reagan did.