Meningitis Compliance: Fill & Download for Free

This week, I had an opportunity to reflect on how other countries afford ‘universal healthcare’, which is what I believe the question intended.Last week one child (living in the US with company provided health insurance) had their annual medical (free). They were asked ‘would you like us to run an STD screen’. They said, ‘yes’ and two weeks later had a $300 copay bill.This week child number 2 (living in the UK) was struck down with, what in due course, was established to be a serious kidney infection. So Accident and Emergency admission, brought straight in and started on IV drip (due to suspected meningitis), some diagnostic x-rays, ultrasounds and a CAT scan, 2 days in a high dependency unit on IV antibiotics. Cost $0. In the US, this would be a list price well over $50k and probably a couple grand copay under even the best insurance.I also had the opportunity in commenting on another quora question to look up the current government spending on Healthcare, because I incorrectly thought the US spent more government money per person (i.e. ‘Free to the user’) than any other country in the world. It turns out that Luxembourg and Norway spend more per capita than the US and the Netherlands spends about the same.So, in the US we spend more government money per person on healthcare than almost any country in the world, and that only covers the old, Veterans, Native Americans, and an arguably poor service for the very poor. Whereas every other developed country covers pretty much every person to a high standard.I can say from recent experience, not having to think about coverage, insurance, copays, etc. when your child is being wheeled into A&E takes a huge burden off ones mind. I say this as well as someone who is in the top 1%, a group that is often characterized as indifferent to spending multi-tens of thousands of dollars on this type of routine healthcare.The US system is fundamentally broken at its core economic level. But it is sad to see that neither side of the ideological divide can understand that.Progressives seem to think extending this expensive system to more people is the highest priority and that eventually ‘single payer’ is going to be a magic solution. This despite the current very large single payer systems of Medicare and Medicaid already spending more money than every other country in the world (except Norway and Luxembourg) spend to provide universal coverage.Conservatives seem to think, ‘if only we had a free market that would solve all of the problems’, neglecting the fact that healthcare is a terribly asymmetric business in terms of consumer/provider information disadvantage, very limited procurement options at the time of consumption, and the whole insurance market operates in the space of risk evaluation and certain current cost offset against contingent future costs, which are all areas in which retail consumers routinely make demonstrably terrible decisions and are provided with large safety nets from various consumer protection laws.Neither side is willing to address the fundamental issues that drive the extraordinary cost base in the US. Examples could be, Medicare being allowed to negotiate pharmaceutical pricing, facilitating global sourcing of DME and pharmaceuticals by recognizing safety certification/compliance from other ‘comparable’ regulatory systems, not allowing recipients of medicare payments to include consumer marketing in their cost base for non-profit status, tax payment, or reimbursement. Mandating the uninsured are billed at the medicare/medicaid rate, removing the massive tax subsidy for company provided insurance plans and replacing it with an ‘Medicare for all tax’ or the employees ability to opt out and buy private insurance or pay cash (possibly after posting bond to cover any emergency treatment), similar to the German system.ps. In case it is not clear, I am not saying all opinion in America falls into the two camps I have summarized, only that those seem to be two common talking positions represented by people in Quora and the commentators in general.

"When is a single dose of IM antibiotics indicated over a course of PO antibiotics?"Question Details: What is the thought process behind going with a single dose intramuscular injection of antibiotics, rather than prescribing the typical 10-14 day course of oral antibiotics?This is an interesting question, since as late as 1960 the mortality rate of peritonitis was close to 100%. So if you had a ruptured appendix you just died. At the time It was imperative to get blood cultures in serious infections, then wait two days for the cultures to come back before starting antibiotics. Physicians were concerned about antibiotic resistance and were very conservative. Naturally, many of these patients became very ill. It was finally realized that multiple antibiotics, started immediately, before the cultures were back, had much better results.Antibiotic therapy ideally is determined by isolation of the offendingorganism and determination of its antibiotic susceptibility pattern.This information is usually not available in the acute setting of the emergency department (ED), and it is often necessary to make treatmentdecisions without precise knowledge of infectious source or microbialspecies. In certain cases (eg, suspected meningitis, gram-negativesepsis, bacterial peritonitis, pneumonia), early empiric therapy may belifesaving.Antibiotics prescribed but not taken are worth little to a sickpatient. Compliance can be optimized by optimizing drug formulation andminimizing frequency of dosing, duration of treatment, unpleasant sideeffects, and cost. (As a young intern working the emergency room, I had a personal experience of this. A man brought his young child in with a fever and infection. After examining the child, I gave him a prescription for antibiotics. He said, "Doctor, my wife left me with 4 small children. I can't afford to get this filled.")For these reasons, single-dose coursesadministered in the ED (eg, benzathine penicillin, cefixime,ciprofloxacin, fluconazole, metronidazole) greatly improve complianceover traditional multiday multidose regimens.Giving a single injection of an antibiotic, if the organism is succeptible, helps the body fight off the infection. Don't forget, our immune systems work very well. It is only when the immune system is overwhelmed that the infection takes over. It is sort of like "heading off the infection at the pass".Single dose antibiotics are also given prophylactically before certain surgeries, for example, Cesarian Sections and lumbosacral operations. This is at the physicians discretion, but studies show the incidence of post-operative infections are less with this strategy.Finally, certain sexually transmitted diseases are treated with a single injection when compliance might be a problem. When this is done, follow-up is imperative.Unfortunately, the blood levels with an IM injection can rapidly drop, and if the infection is still present, then further treatment is essential. That is the reason for the 10-14 day oral course of antibiotics.In summary, single dose injections can be given for:1. Compliance - when there is a risk that an oral dose won't be filled or taken.2. Prophylaxis before certain surgeries with a high risk of infection.3. Some STDs - again because of compliance

I have come across patients recovering and surviving tuberculous meningitis. Treatment compliance is important.