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Q: Antibiotics taken by mouth. ( Answered 5 out of 5 stars,   3 Comments )
Question  
Subject: Antibiotics taken by mouth.
Category: Health > Medicine
Asked by: clicker5-ga
List Price: $8.00
Posted: 15 Mar 2003 22:24 PST
Expires: 14 Apr 2003 23:24 PDT
Question ID: 176844
Example:
When doctors prescribe antibiotics for an infected toe:
Why are the antibiotics prescribed to be taken by mouth?
Why can’t the antibiotic be given with a shot in the toe or foot?
Answer  
Subject: Re: Antibiotics taken by mouth.
Answered By: sublime1-ga on 16 Mar 2003 00:23 PST
Rated:5 out of 5 stars
 
clicker5...

The essential factor seems to be oxygenation, or exposure
to oxygen. This decreases as we age beyond childhood, and 
is further limited by inactive lifestyles. An article by
Tom Valeo, ęSt. Petersburg Times, published February 25, 2003,
notes:

"Onychomycosis (ah-nee-ko-my-KO-sis), or toenail fungus,
 starts with subtle discoloration; the toenail turns yellow
 or dark brown. In rare cases the nail turns white, gets
 powdery and sloughs off. The tip of the nail may thicken
 and become a challenge even for the sharpest nail clippers.
 Debris, or "toe jam," under the nail might develop an odor."

and:

"Toenails need two things to remain healthy: oxygen and attention."

"As we age, less oxygen makes its way to the feet because the
 lungs become less efficient at supplying blood with oxygen
 and the heart pumps blood with less force. As a result, the
 toenails, at the end of our longest appendages, must make
 do with less oxygen."

and:

"Without sufficient oxygen and attention, toenails become
 increasingly susceptible to fungus, an unusually stubborn
 affliction that almost never clears up on its own. Even
 oral antibiotics, the most effective treatment, take weeks
 to eradicate the infection. Topical treatments, such as
 medicated toenail polish, may take longer."

and:

"Fungus thrives in warm, dark, moist environments and loves
 to feast on keratin, the protein that makes up the toenail.
 Blood, rich in oxygen and antibodies, fights this invasion
 effectively, which is why children, who have robust
 circulation in their feet, almost never get fungal toenail
 infections."

"More than half of adults over 65 have problems, says Joshua
 Bernard, a podiatrist and assistant professor of surgery at
 the University of South Florida."

"When we get beyond 60 or so, the skin tends to thin out and
 atrophy," Bernard said. "The blood supply to the tissues,
 including the toenails, tends to decrease, and the body's
 immune system loses vigor."

and:

"The first line of defense against toenail problems is the
 simplest: Wash your feet vigorously every day with soap and
 water. The soapy runoff from a shower is not sufficient."

and:

"Failure to wash the feet vigorously gives fungus an
 opportunity to grow, especially when toenails develop
 tiny cracks. Stubbing your toe or dropping something on
 it can crack the nail, but toenails can suffer "microtrauma"
 as Bernard calls it, simply from rubbing against the inside
 of tight shoes."

"Bernard recommends other simple precautions:

 Change your socks every day.

 Wear flip-flops or aqua socks when using a communal shower
 at a gym or pool.

 Dry your feet thoroughly and apply foot powder.

 Allow your shoes to dry completely before wearing them again.
 For extra protection, swab the inside of your shoes with
 cotton balls soaked in a mild bleach solution."

 Trim your toenails straight across but not too short. And do
 not round the corners because that may encourage the skin to
 swell, leading to an ingrown toenail." 

There's more in the original article:
http://www.sptimes.com/2003/02/25/Seniority/Fighting_off_nail_fun.shtml


Please do not rate this answer until you are satisfied that
the answer cannot be improved upon by means of a dialog
established through the "Request for Clarification" process.

sublime1-ga


Searches done, via Google:

"toenail fungus" "oral antibiotics"
://www.google.com/search?q=%22toenail+fungus%22+%22oral+antibiotics%22

Request for Answer Clarification by clicker5-ga on 16 Mar 2003 01:31 PST
Hello sublime1:
My basic question is:
Why are antibiotics prescribed to be taken by mouth.
Why can’t the antibiotic be given with a shot.

Mentioning the toe, was only an example.
Another example would be:  infection in the leg or the back.
Why can’t the antibiotic be given with a shot
clicker5

Clarification of Answer by sublime1-ga on 16 Mar 2003 11:08 PST
clicker5...

Sorry. I assumed that you had read xarqi-ga's comments and
understood that, as he noted, infections are more effectively
addressed in a systemic manner. The antibiotics must be made
to enter the bloodstream in order to be carried to all parts
of the body. Given that the primary reason for a fungal 
infection in the toe is poor circulation in that area, this
makes it the worst site for the introduction and dispersal of
the antibiotic, not to mention that, due to the large number
of nerve endings in the toes and feet, it would be exceedingly
painful. For this reason, shots are typically given in less 
sensitive parts of the body, with better circulation.

Then there is the matter of maintaining a certain level of
the antibiotic in the bloodstream. This would require 
repeated shots, which means repeated (daily) office visits.
This is simply not desirable for the recipient or practitioners
in terms of cost and time (not to mention pain), especially
when, as the page I cited notes:

"...oral antibiotics, the most effective treatment, take weeks 
 to eradicate the infection"

This implies that injectable antibiotics would take even longer.

The reason that the eradication of this infection takes so long
is, again, due to the poor circulation in the feet and toes
(which is the major contributing factor to the infection in the
first place). If the infection were located in a part of the 
body where circulation was good, it would not take so long, as
evidenced by the routine 10-day course of antibiotics when they
are prescribed for, say, an infection in the mouth, which has
better circulation than most parts of the body.

For the reasons above, it is more common to be given a shot
upon first visiting your practitioner, as this allows a
major initial delivery of the antibiotic to enter the 
bloodstream. This is then followed by pills taken 3-4 times
a day, to maintain the level of antibiotic in the system.
And, of course, this means fewer expensive visits to the 
doctor's office, and fewer painful shots.

I hope that clears things up, but if you need further
clarification, please don't hesitate to ask, before
rating this answer.

sublime1-ga

Clarification of Answer by sublime1-ga on 16 Mar 2003 11:22 PST
clicker5...

Another thought occured to me which might make this more clear.
If you have an infection in a cut on the surface of the body,
you can apply a topical antibiotic, such as bacitracin, to 
eliminate the current infection and prevent it from spreading,
and this can take place very quickly, since the spread of the
infection has not progressed to any degree. 

But when an infection has taken hold inside the body, it means 
that the body's natural defenses (such as white blood cells) 
have already failed. This cannot then be addressed effectively 
with any sort of local treatment, since the infection can
begin to spread (and probably already has) through the 
circulatory systems (as xarqi-ga noted). This must then be
addressed through the very means that the infection is using
to spread - the circulatory system. The rest of the body must
be defended from the infection while it is being eradicated
from the original site.

The advantages of oral vs local injection have already been
discussed.

sublime1-ga
clicker5-ga rated this answer:5 out of 5 stars
Thank you sublime1.
Excellent answer.
clicker5

Comments  
Subject: Re: Antibiotics taken by mouth.
From: xarqi-ga on 15 Mar 2003 22:47 PST
 
Could be.  The thing is that once you have an infection, the bacteria
can distribute through the blood and lymphatic systems.  It is
important to have a systemic treatment.  I guess, most people prefer
to swallow a pill that face the needle.  Drug companies expend a lot
of effort just to improve oral availability.
Subject: Re: Antibiotics taken by mouth.
From: xarqi-ga on 16 Mar 2003 04:06 PST
 
One other point is that many courses of antibiotics take several days.
 Me - I'd rather take the pills than have my already sore toe (or any
other part of my anatomy) further insulted by repeated jabbing.  :-)
Subject: Re: Antibiotics taken by mouth.
From: surgeon-ga on 17 Mar 2003 16:38 PST
 
for an antibiotic (or any medication) to be effective, it must get
into the bloodstream and then, via the blood, to the tissues involved.
Injecting directly into an infected area would mean most of the drug
would sit in the tissues, and would not be able to transport across
the cell membranes until it was absorbed from the area of injection
into the blood, and thence around the park and back to the needy
tissues. Likewise to get the amount necessary over and over in the
same area would become intolerably painful. But the main point is that
it's from the capillary flow of blood that medication finally diffuses
to where it needs to go; injection is just one way of getting it into
the bloodstream. Oral works just as well for many, but not all, drugs.
The body part injected isn't important as long as it's a place with
rich enough circulation to absorb the drug. Finally; someone mentioned
topical antibiotics: they have very limited value, only to cut down on
surface bacteria. They do nothing for an infection anywhere but at the
very surface of the skin; even then, if it's a serious infection at
all, drugs in the bloodstream must be used.

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