Antibiotic discrimination

The issue of racial discrimination is on going uptrend. In America, people the black community that has been oppresssed for quite sometime are demanding their equals right. In our country Malaysia, the Malays are demanding their rights from whoever is oppresing them.

Discrimination can be deadly.

And one the deadliest discrimination is antibiotic discrimination. Some doctors hate certain antibiotic without any particular reason and love another antibiotic also for no reason. For example, cloxacillin. This antibiotic has been around for ages. It has been doing its job quite amazingly clearing up Staphyloccocus infection from every site you can imagine. It is cheap and available in oral form and parenteral form.

But, a lot of people hate it. They favour more fancier drugs such as Amoxicillin-Clavulanate, pipperacillin-tazobactam, cephalosporins, and the most favourite antibiotics among all, carbapenems.

Without any particular reason, people just hate prescribing cloxacillin. It’s not cool. It sound cheap. Some may gave reason that it was painful to be given intravenously. I myself once tried intravenous cloxacillin. When we were house officer, we tend to experience first hand what a patient felt so that we can develop more empathy. It was not pleasurable, I agree. But it was not as bad as it was described. If you dilute it properly, use large cannula, it can be done. Some give the reason of dosing. it was much easier to give something that goes once daily like ceftriaxone instead of 4 times daily like cloxacillin.

So cloxacillin was discriminated. A good and cheap antibiotic but nevertheless subjected to a discrimated judgment among doctors.

But cloxacillin was not the only one. Penicillin...is another one.

Penicillin once called as miracle drugs, saved millions of life, the first antibiotic discovered...this antibiotic have a very good reputation. It is very excellent in treating beta-hemolytic streptococcus like GBS, Streptococcus pyogenes, group C, group G strep... but because of discrimination, rarely doctors prescibed this one. Even if someone have strep throat, doctors tend to prescribed augmentin, cefuroxime,and even azithromycin.

Cephalosporin itself have their discriminated one...like cephalexin. Cheap, good for gram negative UTI, but nobody want to use that.


Now, people love fancy antibiotics. People tend to forget the old and cheap antibiotics. Sadly enough, some didn’t know that this antibiotics work.

The typical statement froma treating clinician was “ can this also cover that?” “ can augmentin also cover gram positive cocci like cloxacillin do?”....

The answer is yes. But why do you want to use broader spectrum antibiotics? Why do we need to give augmentin for strep throat? Why do we need to start carbapenem for community acquired pneumonia? Why do we need to treat urinary tract infection with ciprofloxacin?

Sometime we just don’t realised that subconsciously, we are discriminating certain antibiotics.

We have national antibiotics guideline, it was an amazing guide for all doctors. Amazing but outdated. Recently, pharmacists in Queen Elizabeth Hospital in Sabah introduced their own guidelines. Salute-respect to them. Every hospital should have their own guidelines correlating with their own antibiogram profile so that doctors did not discriminate certain antibiotics.

Everytime you want to prescribed an antibiotic, please think about the indication, the pharmacodynamic and pharmacokinetics, side effects, and be specific as much as possible. With these attitude, those discriminated one could shine brightly with their potential.