Should I take the antibiotics?

April 16, 2009 12:41 PM

MediFilter: Should I take the antibiotics for my staph infection, even though it's getting better?

Saturday morning I woke up with what looked like a spider bite on the top of my foot. By Monday evening it was hurting like hell, so I went to the ER thinking I had a brown recluse bite or something. Doctor at the ER said it was a staph infection, MRSA by the look of it. She gave me a prescription for a couple of antibiotics and sent me on my way. I tried to fill the prescriptions that evening, but the power went out at Publix (yay free antibiotics) so they weren't able to fill them until the next day. I just happened to have an appointment with my family doc Tuesday morning for something unrelated, and got him to look at my foot. He said it didn't look like MRSA to him, took a culture to test and told me to take the antibiotics until he knew more. I got the prescription filled later that afternoon, but didn't take them right away. The next morning (Wednesday) my foot was looking a lot better and the pain was pretty much gone. I decided at that time that I'd just ride it out unless the test results (which I should have tomorrow) tell me it's MRSA. Is this a bad idea? Am I running the risk of blood poisoning or some weird thing by not knocking this out right away? I'd really love if my body could kill this on its own. I'd call and ask the doctor this, but they're closed today.

posted by nzero to health & fitness (39 comments total)

By the way- I know you're not my doctor, etc.
posted by nzero at 12:43 PM on April 16

You should probably rely on the advice two medical professionals have already provided you.
posted by iamabot at 12:46 PM on April 16 [5 favorites]

Just to be clear, I'm not really looking for a debate or even advice on whether or not I should follow the doctors' instructions. I am specifically interested in information about what risks I'm taking by letting a staph infection run its course.
posted by nzero at 12:50 PM on April 16

Agreed. Even if it appears to be healing, there still IS the chance, even if small, that something more serious could happen. You'll have the culture back tomorrow, and that might guide you from there. But if two doctors have already looked at it and said you ought to take antibiotics, you ought to take them.
posted by davidnc at 12:50 PM on April 16

The whole point of a measured treatment of antibiotics is that you take them all, not stop when something "seems to be better." That's not how they work.
posted by rokusan at 12:52 PM on April 16 [3 favorites]

At the very least, I'd keep taking it until you've spoken with a doctor and had the doctor say you can stop.

The reason why there are such high-level bugs like MRSA is because of people who don't finish taking their antibiotic prescription. For a long time, people sometimes would take antibiotics, but then they'd stop when they felt better; however, sometimes you can feel a lot better but still be infected. That's why you usually have some antibiotics left over after you feel better, it's because the stronger-than-normal bacteria in your system need the extra dosage to kill them off. By not killing them off, we've basically imposed Darwinian Selection on them -- breeding even more stronger-than-normal bacteria, and over the years, those stronger-than-normal bacteria have become the NEW normal, and the normal antibiotics don't work quite as well any more.

Of course, if it isn't the right antibiotic for the right infection, you can of course stop without consequence; I had a doctor prescribe me an antibiotic when he was reasonably sure I had strep once, and I felt better the next day, but kept taking it -- only to have my doctor call me the next day after that and say that I tested negative for strep. He said that I could stop taking the rest of my prescription, since it wasn't what was fighting the infection anyway. If your system is what's fighting off the infection, you could stop - but only the test would know for sure whether it's MRSA.

I'd keep taking your antibiotic at least until you find out what the test results are. You probably aren't being severely harmed taking them (there are some side effects to antibiotics, but they won't kill you or anything), but you may make things worse by stopping your prescription now.
posted by EmpressCallipygos at 12:52 PM on April 16 [1 favorite]

Please keep taking the antibiotics unless otherwise directed. Taking an incomplete course just leaves behind the stronger ones, increasing antibiotic resistance.
posted by zsazsa at 12:53 PM on April 16

Er, I guess I wasn't nearly as clear as I thought I was: I have not taken any antibiotics so far. Of course if I had already taken them I would continue.

My question is only: what risks am I taking by not taking any antibiotics whatsoever for a staph infection that seems to be healing on its own?
posted by nzero at 12:54 PM on April 16

I certainly can't give advice on whether the antibiotics are right for you, but if you do start taking them, do not stop unless you have discussed this with your doctor first. In some cases, this is an excellent way to build up a cache of antibiotic-resistant bacteria in your body.
posted by zachlipton at 12:54 PM on April 16

Oh, specifically addressing the risks of letting it run its course...

Highly variable. That's why you get antibiotics. In most instances, a staph infection isn't a big deal and your body can clear it. However, on the other extreme, it can turn into necrotizing fasciitis ("flesh-eating bacteria") or sepsis. The odds of developing necrotizing fasciitis or sepsis are very small, but it does happen. The bigger worry in this case is that you just never know exactly how things will play out -- even if the infection appears to clear initially, you could still have a few particularly nasty organisms in there that, after some time, have reproduced enough to cause something more serious.

All this being said, the culture will bare out whether this really is even staph in the 1st place.
posted by davidnc at 12:55 PM on April 16

It's unclear -- have you started taking them? If so, you should finish.

If you haven't, you can let your body fight it off.

Don't take antibiotics if you don't need'em. But once you start taking your prescription, definitely keep taking them.
posted by musofire at 12:55 PM on April 16

MRSA stands for Methicillin-resistant Staphylococcus aureus - that is, a strain of staph that is already resistant to at least one line of antibiotics. Failing to finish up the course(s) of antibiotics currently prescribed to you runs the risk of (1) not eliminating the infection that you have now; and (2) possibly contributing to the development of strains of MRSA that are resistant to more than one line of antibiotics.

MRSA is no joke. "Letting a staph infection run its course" can lead to sepsis, abscesses, and even death. Very bad strains of MRSA kill people. And if you are regularly exposed to immunocompromised people, you could conceivably transmit it to them. The likelihood of these things happening may be low, but it is non-zero.

So yes, you should probably take the antibiotics. And once you start, you strong>must finish your course of antibiotics.
posted by googly at 12:56 PM on April 16

The internet has a unanimous answer for you. If you stop taking the antibiotics before the bacteria are all killed, they will come back, and be stronger than they were before you started.
posted by darksasami at 12:57 PM on April 16

You say it appears to be clearing up on it's own. Hold off on the antibiotics until you get your test results- if you see any worsening, redness, swelling, heat, streaks, feel pain in the area- start taking them.
posted by hellboundforcheddar at 1:00 PM on April 16

okay, you can't "see" heat... you get my drift.
posted by hellboundforcheddar at 1:01 PM on April 16

OMG, he said he hasn't started taking them yet, and, "Of course if I had already taken them I would continue."
posted by amro at 1:09 PM on April 16

Oh, and I knew a guy that became comatose as a result of a MRSA. If it were me, I'd take the antibiotics.
posted by amro at 1:11 PM on April 16

Please, click on my profile and check out my MRSA post from a year ago. I have been to hell and back as my Mom has contracted this. I really don't want to scare the shit out of you, but this is something that should not be taken lightly. That is how it started off with my mom, and fast forward a year later and it had attacked her heart. She had to have two valves in her heart replaced and a third is failing now as well. (She is diabetic and more susceptible to this sort of thing, but I just wanted to pass on how it CAN be quite a serious thing.)

IA(most definitely)NAD, or even close, but from experience I would first find out if it was MRSA and take the more potent antibiotics you will receive if it does turn out to be MRSA. The thing about it is that is resistant to some forms of antibiotics, and I just would not encourage having antibiotics in your system longer than needed :P
posted by phox at 1:11 PM on April 16

"Letting a staph infection run its course" is pretty much a bad, bad plan.

(Speaking from experience as someone who had to take about 5 different antibiotics for 2 months to fight off an awful staph infection on my foot contracted after I had some work done on it in a doctor's office).

Take the drugs. Seriously. Unless you're having a bad reaction to them, as I did to one of the ones I was prescribed, take them.
posted by bitter-girl.com at 1:12 PM on April 16

Staph is nothing to mess about with. As well as MRSA, Staph can also turn into flesh-eating disease. I'd follow both of your doctors' advice. Maybe nothing will happen, but the consequences of a Staph infection can be very severe.
posted by bonehead at 1:13 PM on April 16

My question is only: what risks am I taking by not taking any antibiotics whatsoever for a staph infection that seems to be healing on its own?

Do a google image search for "staph infection" and see for yourself what the risks are.

It's your foot. You can get all internet-philosophical about it, or you can follow the advice of two separate doctors and take the antibiotics already. Antibiotics won't kill you. Staph certainly can.
posted by gyusan at 1:15 PM on April 16

OMG, he said he hasn't started taking them yet, and, "Of course if I had already taken them I would continue."

...Er...I don't think that changes much of the advice we're giving by much, except to add "you should probably start taking them, then" to the beginning of most comments.
posted by EmpressCallipygos at 1:15 PM on April 16

Look, make your self a little decision chart:

                   Risks         Rewards  
                -------------------------------------------------
                |             |                                 |
Take the drugs  |   none      |   may stop a serious infection  |
                |             |                                 |
                |------------------------------------------------
Skip the drugs  |  infection  |                                 |
                |   sepsis    |   none                          |
                |   death     |                                 |
                |------------------------------------------------                    

The way I see it, there's really no reason not to start taking them immediately. I mean, what's the potential downside?

Yes, the risks may be small-percentage events, but why not be safe when it costs you nothing to do so?
posted by chrisamiller at 1:16 PM on April 16 [7 favorites]

Thank you for the good answers. My plan, as I stated earlier, is to wait to take the antibiotics until I have the test results tomorrow. If it is MRSA, I plan to take the strong antibiotic they gave me for MRSA. Is it ok to wait to tomorrow to take the antibiotics? It's already been 5 days after all, and it seems to be healing...

Also, phox, I'll check out your post.
posted by nzero at 1:19 PM on April 16

chrisamiller: What is the potential downside of taking medicine when my body could fight this off itself? I would far rather rely on my body to take care of something like this than a drug cocktail. On the other hand, I'm not going to die over that principle, so I am trying to intelligently assess the risk involved by querying people more knowledgeable about the subject than myself. Also, I am unconvinced by your chart since in it you 1) assume there is absolutely no risk in taking medicines that are unneeded, 2) no benefit to letting your body heal itself and 3) fail to give extreme scenarios rather than risk levels.
posted by nzero at 1:29 PM on April 16

Er, I meant to say 3) give extreme scenarios, rather than risk levels.
posted by nzero at 1:30 PM on April 16

You're going to get two answers (and you've pretty much already gotten them)

1. Take the antibiotics now as it's not worth the risk.

or

2. Wait for your test results (12 hours from now) and advice from your doc. I'd go with #2 as long as your sore appears to be shrinking/ drying out/ feeling better/ healing/ disappearing/ what have you.


In the meantime you might research the following:

Does MRSA ever clear up on its own?
Can MRSA appear to be healing and then come back with a vengeance/ attack other organs in a period of @12-24 hours?
posted by hellboundforcheddar at 1:32 PM on April 16

Someone close to me got MRSA recently. Turns out you can beat MRSA but it might come back later. Her first MRSA outbreak cleared itself and the second one was huge and didnt. Im not a MRSA expert, but the idea here is that it comes back. If it is MRSA most likely you'll also need a different antibiotic to put in your nose to kill where it lives. Someone you know may have it or might just be a carrier with no symptoms. MRSA is serious business. Take your pills and go to your followup. Trying to fight it on your own is irresponsible if it means a longer period where youre up and about yet still infectious and spreading MRSA.
posted by damn dirty ape at 2:24 PM on April 16

My SO works as a nurse at a hospital. Take the antibiotics.
posted by arimathea at 3:42 PM on April 16

chrisamiller: What is the potential downside of taking medicine when my body could fight this off itself? I would far rather rely on my body to take care of something like this than a drug cocktail.

Are you allergic to the antibiotic? Is a mildly upset stomach going to be a traumatic event for you? If the answers to both of these are no, then antibiotics, as a general rule, will not be dangerous to your health. You're not personally going to save the world from MRSA by selflessly forgoing antibiotics, either, so don't lecture on societal effects.

I don't understand your aversion to modern medicine. It's useful to remember sometimes that "natural" doesn't necessarily mean better. In our "natural" state, life expectancy was very low and people died from routine cuts and scrapes that got infected.
posted by chrisamiller at 3:57 PM on April 16 [1 favorite]

I think a lot of people are missing the fact that the OP isn't planning on skipping the antibiotics if he's got a MRSA skin infection; he's asking whether he should wait something like 8 hours (at this point) to get the results back before taking them given that one doctor said it doesn't look like MRSA and that it appears to be clearing on its own.

OP: If it were me I would have started the antibiotics just about 30 minutes after the doctor wrote me the prescription. But since you didn't and now another doc has told you he doesn't think its MRSA and you have test results coming back very soon, I'd probably wait to get the results.

Needless to say, if the results come back MRSA you better damn well take all the antibiotics whether or not it appears to be healing by itself. Take them all. On time. On schedule. Without excuses. It it isn't MRSA, well, you've avoided taking heavy duty antibiotics which contrary to what someone else said earlier does, in fact, carry a lot of downside risk. Much less downside risk than a MRSA infection but still a risk.
posted by Justinian at 3:59 PM on April 16 [1 favorite]

Here's a less well formatted grid, but one that lays out the pros and cons a bit better (in my opinion).

Take the drugs
Risks: 1) Negative reaction to the anti-biotic. This can be itchy hives, or sore and easily injured joints and ligaments, or gastro-intestinal issues. Read up on the particular antibiotic for the likelihood of adverse reactions. 2) Anti-biotic is not effective against the infection anyway, so your stuck on a round of anti-biotics for no reason.

Benefit: If you do have a staph infection, and the staph isn't resistant to the anti-biotic, the infection will be cleared

Don't take the drugs:
Risks: The infection has moved from the skin to other systems (circulatory, muscle or worst of all, bone). These are life threatening conditions. They may be preceded by pain or fever or other symptoms, but there's no guarantee. It is probably rare for 12-24 delay in treatment to be significant, but it is definitely not unheard of.

Benefit: 1) When you get the culture back you can treat the infection (if it is one) with a targeted anti-biotic, reducing the amount of anti-biotics needed to control the infection. 2) If there is no infection, you spared your body an unnecessary round of anti-biotics.

For some reason anti-biotics really mess with me, I've had allergic reactions, sore joints, and messed up gastro-intestinal issues. I have found a couple anti-biotics that don't mess me up, but it took a lot of trips to the doc to find ones that would work without causing me problems. So *I* would wait, unless I knew I tolerated the anti-biotic well, but this is because of my past experience with both MRSA and anti-biotics. I would NOT wait if there was ANY sign of spreading, pain, or if I had any hint of headache, fever or anything else. On the flip side, if I had never taken anti-biotics before, or knew I tolerated anti-biotics fairly well, I'd just take them.

On preview, I agree with Justinian.
posted by forforf at 6:04 PM on April 16

I know everyone is obsessed with MRSA these days, and there is certainly truth to the fact that some strains of MRSA are associated with more severe, complicated infections, but obsessing about whether or not it's MRSA sort of misses the point.

It's a potential soft tissue infection and it sounds like neither doctor would disagree with that. Whether that infection is due to MRSA, MSSA, streptococcal species, or any other nasty little bugs, it has the potential to become serious and even life-threatening.

The antibiotic spectrum of most drugs used in the treatment of MRSA also tend to cover for other common pathogens in such infections, and the presentation of MRSA infections can be fairly non-specific. I will note that it is common conventional wisdom that MRSA infections often begin with what looks like a bug bite (or what is more likely to be folliculitis).

So the point is do you take the antibiotics that will most certainly help you kick this thing (regardless of what bug might be the trouble maker) or do you play a potentially dangerous game of wait and see. Again, many pathogens implicated in soft tissue infections have the potential to seed the blood stream leading to sepsis, septic shock, involvement of valves, or possibly fascial planes leading to necrotizing fascitis and death. The risk of that is hard to quantify but real. The risk of antibiotics are potentially common mild reactions (eg. nausea, hives) and life-threatening or irreversible reactions are exceedingly rare in most cases. It's up to you to decide. There's no study that compares the outcomes in such infections without any treatment to the outcomes with antibiotics because frankly, to most medical researchers it would be highly unethical and somewhat absurd to approach the question.
posted by drpynchon at 7:25 PM on April 16

If it were me I would have started the antibiotics just about 30 minutes after the doctor wrote me the prescription.

Yep, absolutely. But, if you read my post, I took the prescription to Publix, and then Publix lost power and my prescription got lost in limbo land. They said they would call me as soon as the power came back on, which turned out to be the next day (I had assumed it would be much sooner). Since I had an appointment with my regular doc, I decided to wait just long enough to get the second opinion and, when he didn't think it was MRSA and took a culture, combined with the thing starting to clear on its own, I thought perhaps I should wait until the results came back, i.e. one more day. Then today I started seriously doubting my decision, hence coming on here to ask the question.

Also, I don't have any aversion whatsoever to modern medicine, chrisamiller (would I be here, asking if I should take antibiotics???). I don't understand your aversion to healthy bodies that can heal themselves without medicine in certain cases, or to rational discussion and consideration about what might be best for oneself without blindly following any one person's advice.
posted by nzero at 10:51 PM on April 16

Also, if anyone is interested I decided to start the antibiotics. Thanks for all your input.
posted by nzero at 10:57 PM on April 16

So, is it MRSA? (I hope not)
posted by hellboundforcheddar at 1:43 PM on April 17

You may all be amused at the outcome.

Firstly, I had a severe allergic reaction to the antibiotics and today has not been a fun day (chills, muscle tremors, hallucinations- needless to say, I had to be taken to the doctor).

The test came back from the lab showing no staph of either kind. Doctor thinks this may be because it was already healed too much to provide a good sample. The nurse practitioner told me that, based on other factors, she thinks it is MRSA. The final outcome was a painful shot in the butt, a day of extremely bloodshot eyes, and a splitting headache. On the other hand, my group freshman design team won our design competition today. Even though I could barely stand for the pictures, it was fun.
posted by nzero at 7:02 PM on April 17

Firstly, I had a severe allergic reaction to the antibiotics and today has not been a fun day

I really am sorry to hear that. Given that you've never had an allergic reaction before, the odds were pretty slim. Glad to hear you're okay now.

BTW, I didn't intend any offense with my above statements. It's just that well, I get tired of fighting the anti-vaccinationers and the acupuncturists and the anti-medicine loons, and I suppose I tend to overreact on occasion as a result. Best of luck.
posted by chrisamiller at 6:27 AM on April 22

(I've been in this boat since April as well, after I contracted a skin infection while(? after?) taking antibiotics for a sudden tonsil abscess which led me to an ENT for emergency drainage. I've been told a few tales about whether or not it's the same bug that appeared in my throat, that fixing my depression is the only way to stop the spread of infection, and all sorts of "well, good luck.")

I've got a lab result on the way, but my question is still about diagnosis, as that looks like the best route to successful recovery, and I've had a few of these.

Doctor types: Is there any way to tell from the quality of the infection whether or not it is specifically MRSA staph? Or is that part of its cute little DNA separate from its strength and intensity on human flesh? And as for good old flesh-eating necrotizing fasciitis, how deep is deep, how surface is surface?

(We don't have to get into the sociology again--I really just want this to go away and am ok with allopathic medicine as well as Chinese herbs or voodoo. I've had three rounds of antibiotics and can't shake the feeling that if insurance were covering these trips instead of $89 in cash, I'd get a better diagnosis and the correct antibiotic sooner.)

I will supplement this infinitely valuable free advice with the valuable interpretations of my doctors--Thank you!
posted by JaiMahodara at 12:03 PM on July 24