Print This Article

Ask the Doctor: November 2007

Question: I keep hearing about MRSA on the news. What is it and should I be worried? – M.C., Detroit

Answer: MRSA stands for methacillin-resistant staphalococcus aureus. Staph aureus is a common skin bacterium. It lives on the skin and doesn’t really cause any problems unless it gets under the skin and into the tissue below; it usually enters through a cut or a scrape. Often, your body’s immune system can fight off the bacteria, and you won’t have any problems or sign of infection. Other times, the strain is particularly strong, or the person it is infecting has a weakened immune system for some reason and the infection can require antibiotics. The infection may be treated with a topical antibiotic from the drug store or require a prescription from your doctor for an oral antibiotic.

Resistant strains occur because of overuse of antibiotics. When you have a bacterial infection of any kind, the strongest bacteria are the last to die when you are treated with an antibiotic. When these are exposed to the antibiotic for a long period of time they become resistant and are able to survive, even when exposed.

MRSA first developed in hospitals where very strong antibiotics are used all the time. Now, because people who had MRSA in the hospital and people who work in the hospital may be exposed, MRSA has shown up in infections out side of the hospital.

Preventing MRSA is no different than preventing other infections. Wash your hands often. This is BY FAR the most effective way to prevent any disease from spreading. You do not have to use an anti-bacterial soap because the motion of washing your hands and the water removes most of the bacteria. If you get a cut or a scrape, clean it thoroughly with soap and water. Don’t use hydrogen peroxide, as this can break down some of the normal skin cells and make you more prone to infection. Protect the area with a bandage to prevent any new bacteria from getting in and watch closely for signs of infection: redness or warmth of the area, or drainage of pus from the area.

There are antibiotics that treat MRSA, but they should only be used when the infection is known to be MRSA. If you think you need an antibiotic, go to your doctor. If there is pus, your doctor can culture it to determine if it is MRSA and treat you appropriately.

Question: I see so many ads on TV for sleeping pills. They say they are non-narcotic but I have heard that they can be addictive. Which are they? – T.S., Taylor

Answer: Actually, they are both. The term narcotic really refers to pain medications like codeine and morphine. These drugs are addictive. The sleeping medications advertised on TV are not narcotic pain relievers, so the term non-narcotic is correct.

These sleeping medications fall into a group of drugs similar to Valium, called benzodiazepines. They are much milder than Valium and the other drugs in that class, but they can be habit-forming and addictive and have to be used with caution.

Almost all of the medications advertised on TV should be used in the same way. They should not be mixed with any anti-anxiety medications or alcohol. You should take them at home, right before going to bed and when you are going to get 8 hours of sleep. You should not drive until the effects have worn off (essentially 8 hours after taking the medication).

They should be used sparingly, but most that are currently advertised have been approved for long term use, so they are safe to use long term. The risk of addiction or dependency on the medications increases with the length of time you use the drug.

Question: I saw on the news that the diabetes medication Avandia causes heart problems, but I have not seen anything recently. What is the status of this drug and should I keep taking it? – W. L., Bloomfield Hills

Answer: First of all, do not stop the medication until you talk to your doctor. Secondly, the drug has been reviewed by the FDA and the FDA has chosen to leave the drug on the market, albeit with a warning for patients with moderate to severe heart disease.

That being said, here are the details. The warning basically says to use Avandia with caution and monitor patients closely for leg swelling, unexplained weight gain, shortness of breath or other symptoms of congestive heart failure. It is recommended that the dose be adjusted down or the medication be discontinued if those symptoms occur. Avandia should not be used in patients with New York Heart Association class 3 or 4 heart failure. This is a small group of patients with heart failure that have shortness of breath with mild activity.

JAMA (Sept 12, 2007) has two articles that review the data collected over the years about Avandia and Actos (the other drug in the same class). The review of the Avandia data does show an increased risk for symptomatic congestive heart failure and heart attack, however there was no evidence to show an increase in cardiovascular mortality (death from heart disease) despite the other increases. The review of the Actos data was slightly different. The data did show evidence of increased symptomatic heart failure and so the above warning from the FDA has also been given to Actos. However, there was no increase in the risk of heart attack, stroke or cardiovascular death with Actos.

The most important thing to remember is that uncontrolled diabetes is THE MOST serious risk for heart attack and death from cardiovascular disease. There are other classes of diabetes medication and researchfor new types of diabetes medications is on-going. If you have diabetes, you need to have a discussion with your doctor about which medications are right for you based on your other medical problems and other medications that you are on.

Dr. Karen D. Lockwood is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, please email your question to:

askthedoc@healthandleisureonline.com

* Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.