Regarding the tier 1, one can view things differently. When a patient—after being pumped full of opioids—develops respiratory failure that gets labeled as pneumonia, and is then given antibiotics (which actually raise cortisol levels, thereby counteracting the opioid effect), they will indeed improve. So, apparently, this chain of causality isn't so obvious.
As for survival, one can also look at it this way: if a patient dies because the antibiotic dosages are high enough to destroy their liver and kidneys, doctors will claim the person was terminally ill, had a compromised immune system, or was fighting a resistant bacterial strain. Alternatively, they might attribute the death to cancer (if the patient had it), diabetes, COPD, or another chronic condition. In short, there are plenty of explanations available to account for a death from pneumonia despite the use of antibiotics. So, on paper, antibiotics appear effective against pneumonia. But if you look at the day-to-day reality with even a modicum of critical judgment, the picture is certainly very different.
I agree with much of what you describe, which is why antimicrobial stewardship exists. I spent a good portion of my career stopping unnecessary antibiotics and preventing organ damage from the necessary ones. It was literally my job. I've also seen with my own eyes (and not on paper) what happens when the right antibiotic reaches the right patient in time. Those cases don't make it into the RCTs either. And yes, Osler called pneumonia "the old man's friend" because it was the terminal diagnosis of the underlying disease such as diabetes, COPD, etc.
Thanks for your work. It is fantastic to read an article by somebody experienced, rational and honest in this world where gross misinformation has been "normalised".
I was also interested in the discussion of ARF and RHD. My elder brother probably had these problems when I was about 10 (1964). As a child I had little idea what was going on other than the extreme strain on everybody. I recall the priest coming to the house to administer the rights.
He spent a long time in hospital ~6months. Children in those days of course could not visit. I remember the doctor Dr Howl. I don't think they had much idea what the problem was.
They must have used penicillin because all the kids were given a shot (they suspected hepatitis) and it turned out I was allergic - high excitement. His recovery was long. I recall his bed being moved downstairs as he could not do stairs. He took up piano as he could not stand to play his violin. He grew up a very different child as he had faced death and isolation early. He missed about 3 years of school.
He is going strong today. After a career in engineering, he is just back from a community orchestral tour of Europe playing the viola.
Great story! You bring up a great observation. Before antibiotics, a child got sick and the illness wasn't a five-day inconvenience, sometimes it was months, a year or 2 years. The convalescence became the childhood. It changed the ones who survived. Today the kid gets amoxicillin for strep and is back at school in 48 hours and this produces a fundamentally different kind of childhood as you said. Sometimes I wonder about that. We gained speed. We may have lost something else.
From one pharmacist to another, thanks for this post! Infectious disease was a touch subject but quite interesting. I practiced community so not as specialized as the hospital, but that respect is still there.
Thanks! Great article. I was a certified geriatric pharmacist at one time as well. Big believer in deprescribing. Amazing how much pharmacists really don't like drugs, lol. We know too much about them.
These comments concern the need for at least 50 ng/mL circulating 25-hydroxyvitamin D for the immune system to work properly; tea tree oil as an antibiotic, which is effective to some degree at least against MRSA (Methicillin-resistant Staphylococcus aureus); excessive inflammatory responses being due to an absence of helminths and a hypothesis on why the very high 25-hydroxyvitamin D Coimbra protocol is effective at suppressing much the same set of autoimmune inflammatory disorders as helminthic therapy.
The PDF of Anand Kumar et al. 2006 “Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock” is available at Alexandra Elbakyn’s Sci-Hub:https://sci-hub.su/10.1097/01.CCM.0000217961.75225.E9 .
You are welcome and thanks for the full citation on Kumar. An important paper. Sorry about the comments, forgot to turn them back on. And yes, vitamin D is crucial and I thought of including it but decided against it. Didnt want to get too much into the weeds. Besides your article is terrific and much better than what I would have done. Great work. Currently on 4000IU/day with a 25-hydroxyvitamin D level at over 100ng/mL. Something that is an excellent adjunct for sepsis, and if immunocompetent and a mild infection is high dose vitamin C as per Dr P Marik's work (before Covid and before he got deplatformed). I use liposomal vitamin C 1 g every hour for 6-8hrs to get the infection under control, then every 2-3 hours for the next few days. Trying to emulate the 24g vitamin C infusions over 24 hours Dr Marik used in his landmark paper (together with thiamine and a bit of steroid). That vitamin C protocol has kept me out of hospital as I have mild to moderate autoimmune neutropenia. Works well for viral infections as well.
I updated my article to point to your reply, noting that you supplement vitamin D3 and mentioning your oral approach to emulating Dr Marik's sepsis protocol, as discussed in this 2019-07-03 video: https://www.youtube.com/watch?v=OOmd2R9LM84.
Also, this post is a bit personal. I suffer from autoimmune neutropenia due to a drug I was taking for my rheumatoid arthritis. My bone marrow makes neutrophils but they get destroyed in my blood so my white count shows mild to moderate neutropenia. As a result I am at a moderately elevated risk for bacterial infections, and yes, I have had my share of cellulitis, and UTIs. These are all endogenous infections. So I am always scanning for bites, scratches etc and taking mannose for UTI prophylaxis. My risk for virus infections are low however.
How much mannose do you take for UTI prophylaxis? I'll be 52 next month. I had a medically necessary hysterectomy 10yrs ago. Before that I think I had maybe 2 UTI's in my life but I could pinpoint where they came from. But the last 10 yrs I've had several which I could not for the life of me figure out where they came from. My last UTI included blood which I've never had before. I started taking a cranberry supplement which seems to help & sometimes I can even head them off with OTC Cystex if I start as soon as I start feeling symptoms. Is there any danger of Methenamine in the Cystex causing antibiotic resistance? Thank you so much if you're able to answer. I will keep in you in my rosary intentions.
Mannose is the best preventative I have found. I have suffered since 1985 when I got a severe I fection while pregnant and got dehydrated and needed the emergency room to get hydrated and a different antibiotic. I use Healthmasters Urinary Tract Support every day. But I also keep Azo Urinary Tract Defense handy if I need extra help.
Thank you! I take 500mg twice daily as prophylaxis and also some vaginal estrogen tablets twice weekly. Hate them but this regimen has saved me. Came close to needing hospital for sepsis. Good luck.
Regarding the tier 1, one can view things differently. When a patient—after being pumped full of opioids—develops respiratory failure that gets labeled as pneumonia, and is then given antibiotics (which actually raise cortisol levels, thereby counteracting the opioid effect), they will indeed improve. So, apparently, this chain of causality isn't so obvious.
As for survival, one can also look at it this way: if a patient dies because the antibiotic dosages are high enough to destroy their liver and kidneys, doctors will claim the person was terminally ill, had a compromised immune system, or was fighting a resistant bacterial strain. Alternatively, they might attribute the death to cancer (if the patient had it), diabetes, COPD, or another chronic condition. In short, there are plenty of explanations available to account for a death from pneumonia despite the use of antibiotics. So, on paper, antibiotics appear effective against pneumonia. But if you look at the day-to-day reality with even a modicum of critical judgment, the picture is certainly very different.
I agree with much of what you describe, which is why antimicrobial stewardship exists. I spent a good portion of my career stopping unnecessary antibiotics and preventing organ damage from the necessary ones. It was literally my job. I've also seen with my own eyes (and not on paper) what happens when the right antibiotic reaches the right patient in time. Those cases don't make it into the RCTs either. And yes, Osler called pneumonia "the old man's friend" because it was the terminal diagnosis of the underlying disease such as diabetes, COPD, etc.
Thanks for your work. It is fantastic to read an article by somebody experienced, rational and honest in this world where gross misinformation has been "normalised".
I was also interested in the discussion of ARF and RHD. My elder brother probably had these problems when I was about 10 (1964). As a child I had little idea what was going on other than the extreme strain on everybody. I recall the priest coming to the house to administer the rights.
He spent a long time in hospital ~6months. Children in those days of course could not visit. I remember the doctor Dr Howl. I don't think they had much idea what the problem was.
They must have used penicillin because all the kids were given a shot (they suspected hepatitis) and it turned out I was allergic - high excitement. His recovery was long. I recall his bed being moved downstairs as he could not do stairs. He took up piano as he could not stand to play his violin. He grew up a very different child as he had faced death and isolation early. He missed about 3 years of school.
He is going strong today. After a career in engineering, he is just back from a community orchestral tour of Europe playing the viola.
Great story! You bring up a great observation. Before antibiotics, a child got sick and the illness wasn't a five-day inconvenience, sometimes it was months, a year or 2 years. The convalescence became the childhood. It changed the ones who survived. Today the kid gets amoxicillin for strep and is back at school in 48 hours and this produces a fundamentally different kind of childhood as you said. Sometimes I wonder about that. We gained speed. We may have lost something else.
From one pharmacist to another, thanks for this post! Infectious disease was a touch subject but quite interesting. I practiced community so not as specialized as the hospital, but that respect is still there.
You may appreciate my recent article on how to actually heal healthcare. I foresee we have a lot in common as we’re both off script. Here’s my recent piece if interested: https://unorthodoxy.substack.com/p/4-ways-to-save-healthcare-and-how
Thanks! Great article. I was a certified geriatric pharmacist at one time as well. Big believer in deprescribing. Amazing how much pharmacists really don't like drugs, lol. We know too much about them.
Thanks very much for this most interesting article.
I wrote some extensive comments and then found there was no comments section. I made them into a Substack article at: https://nutritionmatters.substack.com/p/033-maria-gutschis-article-the-case.
These comments concern the need for at least 50 ng/mL circulating 25-hydroxyvitamin D for the immune system to work properly; tea tree oil as an antibiotic, which is effective to some degree at least against MRSA (Methicillin-resistant Staphylococcus aureus); excessive inflammatory responses being due to an absence of helminths and a hypothesis on why the very high 25-hydroxyvitamin D Coimbra protocol is effective at suppressing much the same set of autoimmune inflammatory disorders as helminthic therapy.
The PDF of Anand Kumar et al. 2006 “Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock” is available at Alexandra Elbakyn’s Sci-Hub:https://sci-hub.su/10.1097/01.CCM.0000217961.75225.E9 .
You are welcome and thanks for the full citation on Kumar. An important paper. Sorry about the comments, forgot to turn them back on. And yes, vitamin D is crucial and I thought of including it but decided against it. Didnt want to get too much into the weeds. Besides your article is terrific and much better than what I would have done. Great work. Currently on 4000IU/day with a 25-hydroxyvitamin D level at over 100ng/mL. Something that is an excellent adjunct for sepsis, and if immunocompetent and a mild infection is high dose vitamin C as per Dr P Marik's work (before Covid and before he got deplatformed). I use liposomal vitamin C 1 g every hour for 6-8hrs to get the infection under control, then every 2-3 hours for the next few days. Trying to emulate the 24g vitamin C infusions over 24 hours Dr Marik used in his landmark paper (together with thiamine and a bit of steroid). That vitamin C protocol has kept me out of hospital as I have mild to moderate autoimmune neutropenia. Works well for viral infections as well.
Thanks very much for your appreciative reply.
I updated my article to point to your reply, noting that you supplement vitamin D3 and mentioning your oral approach to emulating Dr Marik's sepsis protocol, as discussed in this 2019-07-03 video: https://www.youtube.com/watch?v=OOmd2R9LM84.
I just saw your 80+ in-depth articles on mRNA injections (so-called vaccines)! I am reading https://mariagutschi.substack.com/p/the-biocorona and https://mariagutschi.substack.com/p/the-biocorona.
Comments are turned back on. Sorry.
Also, this post is a bit personal. I suffer from autoimmune neutropenia due to a drug I was taking for my rheumatoid arthritis. My bone marrow makes neutrophils but they get destroyed in my blood so my white count shows mild to moderate neutropenia. As a result I am at a moderately elevated risk for bacterial infections, and yes, I have had my share of cellulitis, and UTIs. These are all endogenous infections. So I am always scanning for bites, scratches etc and taking mannose for UTI prophylaxis. My risk for virus infections are low however.
How much mannose do you take for UTI prophylaxis? I'll be 52 next month. I had a medically necessary hysterectomy 10yrs ago. Before that I think I had maybe 2 UTI's in my life but I could pinpoint where they came from. But the last 10 yrs I've had several which I could not for the life of me figure out where they came from. My last UTI included blood which I've never had before. I started taking a cranberry supplement which seems to help & sometimes I can even head them off with OTC Cystex if I start as soon as I start feeling symptoms. Is there any danger of Methenamine in the Cystex causing antibiotic resistance? Thank you so much if you're able to answer. I will keep in you in my rosary intentions.
Mannose is the best preventative I have found. I have suffered since 1985 when I got a severe I fection while pregnant and got dehydrated and needed the emergency room to get hydrated and a different antibiotic. I use Healthmasters Urinary Tract Support every day. But I also keep Azo Urinary Tract Defense handy if I need extra help.
Thank you! I take 500mg twice daily as prophylaxis and also some vaginal estrogen tablets twice weekly. Hate them but this regimen has saved me. Came close to needing hospital for sepsis. Good luck.