Help me not second-guess my physician.

December 12, 2014 7:39 AM

New physician could be too quick to pull out the antibiotics...or I might be the unreasonable one. Help me decide. Warning: frank discussion of possible dysentery inside.

I've had a fever and diarrhea, sometimes with blood, for 6 days. I saw my physician briefly on Tuesday, four days in, and we agreed not to take any action because I hadn't had diarrhea in ~16 hours and was feeling okay. Since then, it's come back, along with a low (~1° F) fever.

Without seeing me again, he sent a script for Cipro to my pharmacy, and declined my offer to provide a sample. He told that he prefers to take the broad-spectrum treatment approach and that results could take too long to come back, especially with the upcoming weekend. Fair enough.

But. My previous experiences with Cipro have been unpleasant, and generally end with a few days of fairly severe diarrhea just from the drug itself. Additionally, I'm due to travel to Southeast Asia on the 22nd, and I would prefer not to do so shortly after carpet-bombing my intestinal flora (though I realize that ship may have sailed).

Also, my father may have experienced a ruptured tendon due to Cipro--the fact that he ruptured a tendon is undisputed, the Cipro-relatedness is what's in question--and I'm a worrier, so I worry that we may share some unknown genetic predisposition to that side effect.

I know you're not a/my doctor, but I'd appreciate a sanity check. Should I push back and insist on labwork, or give it a few more days to clear up (or not) before starting the antibiotics? Or am I making something out of nothing?

posted by anonymous to Health & Fitness (13 answers total)

Bloody diarrhea is an indication for antibiotics, regardless of the lab work (I can provide cites if you'd like). But you can ask for a different type of antibiotics rather than Cipro if the tendon rupture thing is going to keep you up at night. It's a very rare side effect.
posted by treehorn+bunny at 7:45 AM on December 12, 2014 [15 favorites]

Having infectious diarrhea for a week that isn't resolving spontaneously with just fluids and rest is another indication for antibiotics in most people's books, by the way.
posted by treehorn+bunny at 7:47 AM on December 12, 2014 [8 favorites]

I've had Cipro and I wouldn't be in a hot hurry to repeat the experience either, but Docs don't prescribe it unless they think it's really necessary. It's VERY expensive and it's pretty extreme.

You may want to reschedule your trip if you're not feeling tip top by the 20th. You may be able to do it with a doctor's note, especially if you bought trip insurance.

Sorry you're going through this.

P.S. You got a second opinion with my cousin Treehorn there. She's a doctor.
posted by Ruthless Bunny at 7:57 AM on December 12, 2014 [1 favorite]

Talk to your doctor/pharmacist about taking probiotics during and after your course of antibiotics. They have been shown to reduce digestive side effects and post-antibiotic C. difficile infections.

It seems logically like taking probiotics and antibiotics at the same time will cancel each other out, but studies seem to suggest that maintaining probiotic use throughout the course of antibiotics contributes to more stable levels of "good bacteria."
posted by muddgirl at 7:58 AM on December 12, 2014

When I was butt sick for two weeks straight I would have killed for a doctor to prescribe me an antibiotic so easily. People used to die (and still do, in poor areas of the world) from pooping themselves back in the day. We're past that now. Take your Cipro and thank your lucky stars that you live in a place and time with safe medical care.

My experience with Cipro was that one day I was pooping myself to death [took a pill] and then the next day I wasn't. It might be the single best prescription drug experience I have ever had.
posted by phunniemee at 8:01 AM on December 12, 2014 [2 favorites]

P.S. You got a second opinion with my cousin Treehorn there. She's a doctor.

I am a doctor, but please don't consider me a second opinion. I appreciate the vote of confidence from RB, but I cannot give medical advice over the internet, only provide general information about medical conditions and their treatment.
posted by treehorn+bunny at 8:15 AM on December 12, 2014 [15 favorites]

All you bunnies stick together.

I am not a doctor or a bunny, so take this for what it is worth. If it were me, I would consider the risk of not taking it versus taking it and also consider that the person suggesting I take it went to medical school, spent years in training and presumably has some experience.

I would take the Cipro
posted by 724A at 8:22 AM on December 12, 2014 [1 favorite]

Also not a doctor. Staying hydrated is important, too. You may well already know this. But if not ... please look into it.
posted by doctor tough love at 8:34 AM on December 12, 2014

If I'm given antibiotics, I take them. That being said, I will not take Cipro because I am an edge case who had a violent reaction to it. That you should be taking antibiotics is likely good and true; that you MUST take the only type prescribed to you is maybe a little more flexible. Call up your doc and tell him that you feel even worse on the Cipro and you'd like to switch to a different antibiotic if possible.
posted by Hermione Granger at 8:56 AM on December 12, 2014 [3 favorites]

I'm with you, I hatehatehate Cipro. I'd ask the doctor if they'd be willing to give you a different antibiotic. If they feel it's the best antibiotic for the job (and even if they prescribed something else) I'd try to supplement it with the best probiotics out there as an attempt to recolonize your gut flora.
posted by ldthomps at 8:59 AM on December 12, 2014 [1 favorite]

Just got back from India; my travel doc gave me an antibiotic prescription to take with me and basically said:
no blood --> fluids/BRAT
blood --> antibiotics

I have also had not-great experiences with cipro in the past (no side effects, but I have had several infections that were resistant to it and so I wasted time taking it when I should have been taking something else). I don't think there would be an issue with asking for a different antibiotic. You may also want to ask your doctor if there's a probiotic (or yogurt) you can take, and if so, how far spaced does it need to be from the antibiotic dose. If you're female, I'd also consider bringing Monistat or another yeast infection treatment on the trip with me, lest the antibiotics result in that lovely side effect while traveling.
posted by melissasaurus at 9:07 AM on December 12, 2014 [1 favorite]

Isn't dysentery most often a bacterial thing, anyway? I mean what other treatment were you thinking of? I suppose there are other antibiotics you could have been prescribed, but it kind of is what it is unless you're thinking you don't have dysentery at all, or that you think there's a strong indication that you have the viral (???) version.
posted by Sara C. at 10:44 AM on December 12, 2014

I also hate Cipro, I've definitely worried about the tendon thing, and I'd probably ask for another antibiotic (and I think you should do that if you'd otherwise go untreated or wind up taking the Cipro for just a few days). But just want to highlight here that you've had "a fever and diarrhea, sometimes with blood, for 6 days". It's easy to see why your doctor might want to move on this quickly. I would probably not wait a long time (i.e. several days or a week for whatever labwork you're hoping for) to pick and choose, either. I would reschedule the trip or see about flexibility there with the airline.
posted by cotton dress sock at 1:12 AM on December 13, 2014