From episode 158 on the medicine feed. With Dr. Nellie Choi.
You know when you get your ear culture results back, and it's filled with more R’s than a pirate convention? So now what? According to your results you are out of antibiotic options.
Dermatologist Dr. Nellie Choi shared the following insights:
• Culture and sensitivity results are based on the required serum levels of the antibiotic when delivered systemically. But we’re using the drug topically.
• Even if the culture says the bacteria is resistant, you are more than likely going to clear the infection if you are drowning the bacteria with a topical antibiotic, because you are achieving such high concentrations of the drug.
• Pro-tip: Topical treatment failure is often not due to antimicrobial resistance; it’s usually because:
- There is too much debris in the ear.
- There is a biofilm involved. (Pseudomonas specifically are great at protecting themselves with a biofilm.)
• These ears need a good GA and ear clean, NOT a new antibiotic.
• Which begs the question: is your client’s money better spent on an ear clean, or a culture?
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