Q: I would like to comment on the question of drugs sitting in mailboxes in cold weather. When I worked at a major chain drugstore in West Virginia years ago, I remember receiving a pint bottle of a liquid medication that was frozen as solid as a rock.
The huge 18-wheelers in which drugs are delivered from the chain warehouse to individual stores are not temperature-controlled. If the truck leaves the chain warehouse at 8 a.m. and makes its final delivery at 6 p.m., the drugs have been sitting in a stone-cold truck for 10 hours. So mail order is not the only situation in which drugs might be at risk from extreme weather.
A: Thank you for pointing out this weak link in the drug-delivery supply chain. This is something that has worried us for quite a while. We hope that pharmacies will address this problem before too many more years go by.
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Q: A friend of mine almost died from C. diff diarrhea that she developed after taking the antibiotic clindamycin. She had to be hospitalized for two weeks, and she had bad diarrhea at least 30 times a day.
She was scheduled for a stool transplant, but her husband got her into a clinical trial for a drug called Dificid. After two weeks on this antibiotic, she recovered, and she has now been well for several years.
It seems to me that doctors don’t do a good job diagnosing and treating this problem. Shouldn’t doctors and dentists be more careful about prescribing clindamycin, considering the horrible effects of this infection?
A: C. diff is shorthand for Clostridium difficile infections. When these bacteria take over the colon, they can cause dreadful diarrhea that can be quite difficult to treat. Antibiotics such as clindamycin can kill off some of the normal intestinal flora and throw it out of balance, allowing C. diff to dominate and wreak havoc.
Dificid (fidaxomicin) was approved in 2011 specifically for treating Clostridium difficile intestinal infections. Adverse reactions of this drug include nausea, vomiting, diarrhea, stomachache and headache. Another side effect is financial: A 10-day course of Dificid can cost more than $3,000.
An alternate treatment is fecal transplant. A recent review found that a liquid suspension of stool from a healthy donor (administered by colonoscopy, enema or nasogastric tube) is a safe and effective method for treating C. diff infections (Journal of Clinical Gastroenterology online, Jan. 16, 2014).
Asthma and infections
Q: I have asthma and have found that the drugs my doctors prescribe don’t do very much for me. I was intrigued by something you wrote about asthma being caused by infection. Both my family physician and my specialist say this is totally bogus. What is the evidence? I’m fed up with the coughing and wheezing.
A: There is increasing evidence that some cases of hard-to-treat asthma are triggered by a chronic lung infection. To learn about the research behind this approach and the antibiotic treatment that has been used successfully, you may be interested in the book ”A Cure for Asthma? What Your Doctor Isn’t Telling You – and Why,” by Dr. David Hahn. You can share it with your physicians so they can review the science for themselves. The book is available online. Your doctors also may want to read a recent review of this approach in Current Allergy and Asthma Reports (December 2013).
Reach Joe and Terry Graedon at PeoplesPharmacy.com.