Comments on: Clostridium Difficile

By: McGarr Solicitors » Evidence-based medicine

McGarr Solicitors » Evidence-based medicine — Mon, 09 Jun 2008 09:01:15 +0000

[...] proposition was the subject of a post HERE in [...]

By: Edward McGarr

Edward McGarr — Thu, 28 Feb 2008 23:21:16 +0000

Dear JF,

I hold to my view. My subject is proximate cause, not every cause. Prescription of antibiotics is not per se wrong; “overprescription” is a judgment relevant to a social context, not a patient context. In the social context the doctors are anonymous, (and possibly defensible, even generally). The Minister’s prognostications are made with a view to evasion of political responsibility and not otherwise.

By: JF

JF — Wed, 27 Feb 2008 00:44:19 +0000

This is more than a claim, the link with overprescribing is scientifically validated and has been shown by numerous publications for decades. The prescribers are not anonymous as they have to sign each prescription (admittedly not always legibly). The antibiotics cause the problem but I agree that lack of cleaning, handwashing and overcrowding help the spores spread. As this is a multifactorial process there are many in the chain to blame. Unfortunately our aging population and a new more virulent strain mean that this will be an increasing problem in the future. My fear is that it will take a Maidstone scale outbreak to prompt the HSE to provide the necessary resources i.e. more staff, more isolation rooms and proper cleaning and decontamination facilities.

By: Edward McGarr

Edward McGarr — Tue, 26 Feb 2008 09:45:36 +0000

Dear JF,

My fundamental objection to your claim, and that of the Minister is that it transfers the responsibility for what is wrong to anonymous unidentifiable persons (“doctors”) from whom we will not receive an explanation or a defence.

By: JF

JF — Mon, 25 Feb 2008 23:54:09 +0000

Your casual dismissal of the overprescribing of antibiotics betrays a superficial level knowledge of this topic. While not the only cause and decontamination, patient isolation and handwashing certainly have a role to play, the overprescribing of antibiotics (especially those with a broad spectrum) destroys much of the normal bowel bacteria allowing C difficile to fill the ecological gap. Unnecessary antibiotics are a major cause of C difficile. I suggest you read the IDSA antimicrobial stewardship guidelines for a good review of the topic and what Irish hospitals should be doing.