I think too often the public’s attention is captured by new medical discoveries while forgetting older methods that have worked well for us for years.
I have not seen any recent articles on the use of probenecid with Tamiflu, or the use of bacteriophages to treat our present MRSA epidemic.
If given my choice, I’d pick a box of masks, gloves and a bar of Dial soap over 10 caps of Tamiflu to avoid the flu.
What are your thoughts on it?
I agree that the industrialized nations of the world as a global society and medicine as a profession have both become far too dependent on ever escalating doses of medications to solve major public health problems. The great medical philosopher Benjamin Franklin once said, “An once of prevention is worth a pound of cure.” Your masks (in 1918 a handheld cloth handkerchief), gloves and soap will do far more to treat future epidemics and pandemics (influenza, MRSA, SARS, or who knows what) than any pharmacologic agent.
The problems with any pharmacologic solution are side effects, resistance, compliance and prescribing practice. Our current MRSA problem is the direct result of the overuse of antibiotics, especially for “prophylaxis” after low risk lacerations and “treatment” of upper respiratory infections most of which are viral. Add to this the fact that many patients save “left over” antibiotics from prior prescriptions only to use them at a later date thus creating two incomplete treatment periods and bacterial resistance rapidly develops leading to MRSA (and other resistance problems).
Bacteriophages may one day hold the promise of disease targeted treatment, but chaos theory as it relates to mutation and genetics dictates that resistance will eventually develop even to these targeted therapies. The best solution is the oldest, a correct diagnosis linked to a specific and conservative treatment with full compliance to the treatment on the part of the patient.
The use of probenecid to raise the serum levels and area under the curve for Tamiflu (or Relenza) is an interesting theoretical solution to the need for double dose antivirals to treat H5:N1. Unfortunately, the degree of serum level elevation and area under the curve change that would result from probenecid in a given patient is unpredictable. Further, increase serum drug levels, whether from increased dosing or probenecid, will increase side effects including psychosis, depression, suicidality, toxic epidermal necrolysis and Stevens Johnson reactions. Like any pharmacological solution, risk and benefits must be weighed and Ben Franklin’s lesson must be updated for the new millennia…
An ounce of soap is worth a pound of medication!
