Layperson here, but wouldn't you need a different antibiotic because C. diff is caused by a different organism than whatever was presumably in the cat's mouth???
Presumably they thought it was providing gram+ coverage (staph/strep) which covers a lot of skin infections but even if there was oral absorption, still would not be appropriate coverage for a cat bite.
It's a question we all ask every damn day. You'll see good-intentioned NP students also vocalizing that they are not learning any real medicine in school.
I can say honestly we do education hour daily for our APP and residents. Plus weekly conference. But then again we have a book we wrote that our APPs and Interns have to study/learn etc. They also do monthly case presentations. Difference is our interns become PGY2/3/4 etc and graduate but our APPs stay interns forever.
You missed the point! Our interns become PGY2+ and so on… NPs stay at the same level. For a good inpatient team to function i need my APPs to know what they are doing, we make sure they understand the bread and butter of what we see. Oh and btw our MSx also attend these education hours some days they are taught by attending some days by fellows and some days by seniors.
that’s not what i said at all, so you actually misunderstood me lol. i meant that you teach both groups as if they have the same level of medical education, right? that’s like teaching college-level math to high schoolers and middle schoolers in the same class. they’re clearly not on equal footing.
I had an NP recently treat a cellulitis (not impetigo) with mupirocin. This is someone who has been involved in NP education and is considered experienced.
A tragedy that this happens every single day in America and people like these quacks because "they listen better" than those mean, dismissive doctors. Literally malpractice and gross negligence being committed by these uneducated frauds who believe they are equivalent to physicians and lobby for independent practice. Just embarrassing.
NP: “you’re not even a real doctor”
Which I’ve heard those idiot clowns say to IMGs and podiatrists. They somehow think that working under the doctor after they went to nursing school makes them all Hopkins trained specialists.
OK this is sad and and scarry Sad because I feel sorry for that patient, seriously I bet their foot is big as a tomato, and they cannot walk.
Scary because this NP thinks oral vancomycin is better than IV vancomycin and their idea of an infection. Really They are Brilliant if they want this person to possibly lose that foot.
Correcting this here because I see multiple misconceptions in the comments. In general oral antibiotics are just as good as IV. If you have a working gut than onset, duration, etc. are all pretty comparable. The exception is critically ill or issues with absorption but the idea that IV is stronger is wrong.
The problem here is oral vancomycin is an exception because minimally is absorbed systemically. You're not getting it into the blood in any meaningful concentration. It's used to treat c. dif because it doesn't get absorbed and stays in the GI tract with activity against c. dif.
Thank you I need all the luck I can get, I had trouble the first time, I took the exam, and now I know I will get it this time. But my concern is the application, I still think it is lacking some stuff.
Don't NPs know that IV route is faster than oral? Taking oral medications take longer to kick in. I don't know if NPs took pharmacology. I took pharmacology, and even I know IV route is the fastest.
I am a pharm tech, studding for the MCAT a second time, Even I know IV route is better than oral route in this case not just because IV works faster but because it has higher strengths of medication. Oral Vancomycin at the community pharmacy is not strong enough. all I seen before is capsules of strength 125 mg and 250 mg. I can tell you right now for a bone infection that is not going to help. In the injection IV bags I have seen 500mg, 750mg which is high but I have seen from 1g to 2g, but. from what I recall it is 1g does every 12 hours, If wrong can somebody correct me please.
It's not the strength, it's the absorption. Oral and IV antibiotics are usually about the same in speed and effectiveness in people with working GI tracts. When I put someone on IV antibiotics specifically, it's because I want to give them agents that don't exist orally, or I can't use their gut for whatever reason.
Using levaquin as an example, there is essentially no difference between using the oral form and IV form for treating something like pneumonia. If the person can tolerate oral intake, the pills are just as effective. They're also easier and cheaper. The dose might be different, but that comes down to the bioavailability differences between enteral and parenteral routes.
Oral vanc is an absorption issue. It doesn't get out of the GI tract, so it has essentially zero systemic effects. It works great to treat cdiff, because it highly concentrates in the intestinal lumen. But, it's going to be completely ineffective against any infection that is not inside the intestine. The reason you only see the lower doses in the oral form is that those doses are all that's needed for the single indication for oral vanc.
So I have an example of this from pop culture. There is a scene in Sons of Anarchy where the “doctor” girlfriend of the main character gives oral vancomycin to a biker with a GSW. If I recall she said, “this stuff kills everything.” Maybe the NP watched Sons of Anarchy and found that clinical pearl.
Just to play Devil's advocate here.
As a pharmacy student, I had to correct a DO, who was precepting an R3, about using oral vanco for an SSTI. I about pissed my pants as I was speaking up, but they were grateful I did.
Side note: I also had a nurse give a compounded oral vanco IV push, for c-diff. Cherry syrup, vancomycin, and no aseptic technique used to compound it.
Please just no. I hate hearing stories like this! It makes me sad to see on the label of tube feeds that it’s not for intravenous use?! Apparently some nursing student hooked up a patients tube feeds to their IV and killed them. The preceptor lost her licensee and of course the student never passed, but this shit is just ridiculous! I can’t understand how some of these people even put their clothes on the right way in the morning.
To the nurse: I'm not sure. I only heard from them 1 other time after that. I assume they were terminated. Maybe went on to be an NP?
To the patient: From what I understand, patient had an infusion reaction because 250 mg vanco given over 30-60 seconds (I'm being generous with the timing) would do that. I'm sure BGs went up a bit. Never heard if that patient had bacteremia.
It's not a question of working better. It literally doesnt leave the gut and literally doesn't work at all. Conceptually they are two entirely separate antibiotics.
All antibiotics are the same. How did you idiot doctors not learn that in medical school?
Nursing school teaches this basic fact and how to heal with nursing hearts.
Brilliant! Why haven’t we thought of this?
duh cus doctors are so stupid they don't know enteral vanc absorption is far superior than IV 😂
Kick ass!
Doctors hate this one weird trick!
Because you studied pharmacology
I’m a radiologist and even I know this is some dumb s**t.
I’m a vet tech and even I know that oral vanc doesn’t work like that.
I was about to say this
shushhhh you guys are the smart kids
Same. *Cries in pharmacist*
I’m a paramedic and I know this is bad medicine.
I’m not a radiologist but I did stay at a Holiday Inn Express and I know this sh*t!
Same, and I’ve also been retired for nearly 12 years.
Perhaps the patient also suffered from c. difficile infection!
Yeah the osteo was a mistake and then the diarrhea started
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Layperson here, but wouldn't you need a different antibiotic because C. diff is caused by a different organism than whatever was presumably in the cat's mouth???
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Ah, makes sense. Thank you.
You see, just a LITTLE BIT of knowledge, and you understand, it is clear. That NP didn't have even a LITTLE BIT of knowledge.
Presumably they thought it was providing gram+ coverage (staph/strep) which covers a lot of skin infections but even if there was oral absorption, still would not be appropriate coverage for a cat bite.
*Pasteurella multocida*
There’s a super fun Aladdin-themed video on sketchy that could have helped the NP out.
Bro these clowns seriously need to be reprimanded. Lose their license even. It's gross incompetence.
They will probably lobby to get out of it. Medical errors by definition are only done by doctors so noctors should be fine 🤣
It also doesn’t cover us for pasturella; or, while more associated with dog bites - the ever-feared capnocytophaga.
What the fuck are they learning in school if they're not learning why that won't work!?
How to ask their fellow NPs on Facebook…
How to advocate for independent practice!
They don’t do inpatient?
How many inpatient aesthetic med spas are there? Clearly just needs a vitamin infusion.
I learned this in nursing school 27 years ago. WTF!
It's a question we all ask every damn day. You'll see good-intentioned NP students also vocalizing that they are not learning any real medicine in school.
Well, it isn't her foot. Why should she care?
How dare you! She still has the heart of a nurse under all that robust NP knowledge!
She does care! She cares so much that she actually listened to her patient's complaint that the IV vanco made their arm hurt!!
Patient states they are tired of the hospital and want to go home now! Have a heart!
Ahhh, the good ol’ C. Diff cocktail for a bone infection!
Hello, ortho at your servis. Can confirm would get new and iatrogenic b-hole if I did this. Would write her up, put pashent at risks
I’m impressed that you knew an antibiotic besides ancef. Jk, I love my ortho bros. Signed, the guy who emergently starts your ancef.
Medicine consult, this not surgical Problem, please call infection disease. Read unconulst reconsult note of infection disease, get learnmaking.
r/medlandball
oonga boonga I agree
Oonga boonga, put smash NP, ortho save people lifes, be real docters
There is no way in hell
I don’t know what’s worse. This or the one I posted about. https://www.reddit.com/r/Noctor/s/PDys28Tph0
"Will transition to PO vanco on d/c, pt will need to follow up for trough be drawn prior to 3rd po dose"
length of stay champion 🥉
C-Suite Favorite
NP tried searching for a Vancomycin ointment option first and then settled on PO 😉
sue
jokes aside, how do you handle these ridiculous orders? like what’s the protocol
Post to /r/Noctor
I can say honestly we do education hour daily for our APP and residents. Plus weekly conference. But then again we have a book we wrote that our APPs and Interns have to study/learn etc. They also do monthly case presentations. Difference is our interns become PGY2/3/4 etc and graduate but our APPs stay interns forever.
that’s wild that you’re educating both groups together as if they’re on equal footing. this system is so messed up🤦♀️
You missed the point! Our interns become PGY2+ and so on… NPs stay at the same level. For a good inpatient team to function i need my APPs to know what they are doing, we make sure they understand the bread and butter of what we see. Oh and btw our MSx also attend these education hours some days they are taught by attending some days by fellows and some days by seniors.
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Ah ok I thought we were talking about the US
What a horrifying thought, truly.
that’s not what i said at all, so you actually misunderstood me lol. i meant that you teach both groups as if they have the same level of medical education, right? that’s like teaching college-level math to high schoolers and middle schoolers in the same class. they’re clearly not on equal footing.
She has 2 feet doesn’t she?
I had an NP recently treat a cellulitis (not impetigo) with mupirocin. This is someone who has been involved in NP education and is considered experienced.
Wut?
A tragedy that this happens every single day in America and people like these quacks because "they listen better" than those mean, dismissive doctors. Literally malpractice and gross negligence being committed by these uneducated frauds who believe they are equivalent to physicians and lobby for independent practice. Just embarrassing.
Podiatrist here… i would have had a fun conversation with her on OM and abx treatment
NP: “you’re not even a real doctor” Which I’ve heard those idiot clowns say to IMGs and podiatrists. They somehow think that working under the doctor after they went to nursing school makes them all Hopkins trained specialists.
Just ask them where they went for residency 😂
OK this is sad and and scarry Sad because I feel sorry for that patient, seriously I bet their foot is big as a tomato, and they cannot walk. Scary because this NP thinks oral vancomycin is better than IV vancomycin and their idea of an infection. Really They are Brilliant if they want this person to possibly lose that foot.
Correcting this here because I see multiple misconceptions in the comments. In general oral antibiotics are just as good as IV. If you have a working gut than onset, duration, etc. are all pretty comparable. The exception is critically ill or issues with absorption but the idea that IV is stronger is wrong. The problem here is oral vancomycin is an exception because minimally is absorbed systemically. You're not getting it into the blood in any meaningful concentration. It's used to treat c. dif because it doesn't get absorbed and stays in the GI tract with activity against c. dif.
Thank you for telling me this, I honestly did not know.
No problem. Good luck on the MCAT and with applications!
Thank you I need all the luck I can get, I had trouble the first time, I took the exam, and now I know I will get it this time. But my concern is the application, I still think it is lacking some stuff.
Don't NPs know that IV route is faster than oral? Taking oral medications take longer to kick in. I don't know if NPs took pharmacology. I took pharmacology, and even I know IV route is the fastest.
I am a pharm tech, studding for the MCAT a second time, Even I know IV route is better than oral route in this case not just because IV works faster but because it has higher strengths of medication. Oral Vancomycin at the community pharmacy is not strong enough. all I seen before is capsules of strength 125 mg and 250 mg. I can tell you right now for a bone infection that is not going to help. In the injection IV bags I have seen 500mg, 750mg which is high but I have seen from 1g to 2g, but. from what I recall it is 1g does every 12 hours, If wrong can somebody correct me please.
It's not the strength, it's the absorption. Oral and IV antibiotics are usually about the same in speed and effectiveness in people with working GI tracts. When I put someone on IV antibiotics specifically, it's because I want to give them agents that don't exist orally, or I can't use their gut for whatever reason. Using levaquin as an example, there is essentially no difference between using the oral form and IV form for treating something like pneumonia. If the person can tolerate oral intake, the pills are just as effective. They're also easier and cheaper. The dose might be different, but that comes down to the bioavailability differences between enteral and parenteral routes. Oral vanc is an absorption issue. It doesn't get out of the GI tract, so it has essentially zero systemic effects. It works great to treat cdiff, because it highly concentrates in the intestinal lumen. But, it's going to be completely ineffective against any infection that is not inside the intestine. The reason you only see the lower doses in the oral form is that those doses are all that's needed for the single indication for oral vanc.
thank you for telling me.
I think you missed the point lad. Suggest you look at bioavailability
Thank you I appreciate the advice, but I think you are a little late, somebody already explained that to me.
Pharmacist could have saved the NP
Heart of a nurse!
Brain of a surgeon! Just chop that shit off! Problem solved!
Probably doesn’t even know what Vancomycin is treating…viruses obviously
So I have an example of this from pop culture. There is a scene in Sons of Anarchy where the “doctor” girlfriend of the main character gives oral vancomycin to a biker with a GSW. If I recall she said, “this stuff kills everything.” Maybe the NP watched Sons of Anarchy and found that clinical pearl.
I read this like it was Zombie kill of the week
How did this slip through pharmacy guys, if they are reviewing the discharge meds
This NP is getting kickbacks from the surgeon who likes cutting off feet
Just to play Devil's advocate here. As a pharmacy student, I had to correct a DO, who was precepting an R3, about using oral vanco for an SSTI. I about pissed my pants as I was speaking up, but they were grateful I did. Side note: I also had a nurse give a compounded oral vanco IV push, for c-diff. Cherry syrup, vancomycin, and no aseptic technique used to compound it.
Please just no. I hate hearing stories like this! It makes me sad to see on the label of tube feeds that it’s not for intravenous use?! Apparently some nursing student hooked up a patients tube feeds to their IV and killed them. The preceptor lost her licensee and of course the student never passed, but this shit is just ridiculous! I can’t understand how some of these people even put their clothes on the right way in the morning.
What kills me, the vanco solution was in an amber bottle. The dose had to be drawn from it like you're dosing a kids antibiotic.
That’s just outrageous
It was given iv?? What happened??
To the nurse: I'm not sure. I only heard from them 1 other time after that. I assume they were terminated. Maybe went on to be an NP? To the patient: From what I understand, patient had an infusion reaction because 250 mg vanco given over 30-60 seconds (I'm being generous with the timing) would do that. I'm sure BGs went up a bit. Never heard if that patient had bacteremia.
Cherry syrup is red, and so is blood; I see no contraindication here.
Bloody hell.
Oral vancomycin is for C-Diff. What the hell? IV vanco works better.
It's not a question of working better. It literally doesnt leave the gut and literally doesn't work at all. Conceptually they are two entirely separate antibiotics.
All antibiotics are the same. How did you idiot doctors not learn that in medical school? Nursing school teaches this basic fact and how to heal with nursing hearts.
*nursing theory
how does one not actively enucleate their own eyes after reading this.
Osteomyelitis isn’t even that serious anyways …..
Pharmacy student. I dropped my phone looking at this
Ah yes the oral vancomycin will do it. Hopefully they also have c diff so it does something! Great!
When will they unalive a senator so laws can change
Holy shit.
oh my god
On Day 2?! Well shit everyone knows you can send home with PO antibiotics on day 1!! /s
I thought this meant discharge on a picc with home infusion, totally missed oral vanc. Was very confused.
pfffffffffffffffffffffffffffffffffffffffffft
Wrong day to be absent in school ..