One doctor prescribed more than a million hydrocodone tablets

A California diet center doctor known by patients as “Candy Man” was sentenced to four years in federal prison for dispensing what authorities said were massive amounts of powerful painkillers in exchange for cash.

Records revealed that he ordered more than a million hydrocodone tablets in 2008, more than any other doctor in the nation.

Prosecutors estimated that he made nearly $700,000 that year from selling controlled substances. However, authorities said they couldn’t account for 75% of the pills purchased over a 13-month period because he didn’t keep records of the transactions.

In the meantime, the NYTimes reports that Florida is shutting ‘Pill Mill’ clinics. Florida has long been the nation’s center of the illegal sale of prescription drugs: some doctors there bought 89% of all the Oxycodone sold in the country last year. This has changed dramatically with the introduction of new legislation.

References:
Doc gets 4 years for dispensing drugs for cash. MSNBC.
Florida Shutting ‘Pill Mill’ Clinics. NYTimes.
Image source: public domain.

Antibiotics prescribed during 21% of pediatric ambulatory visits; 50% were broad-spectrum

Antibiotics are commonly prescribed for children with conditions for which they provide no benefit, including viral respiratory infections.

The researchers used the National Ambulatory and National Hospital Ambulatory Medical Care surveys from 2006 to 2008, which are representative of ambulatory care visits in the United States.

Antibiotics were prescribed during 21% of pediatric ambulatory visits; 50% were broad-spectrum, most commonly macrolides. Respiratory conditions accounted for >70% of visits in which antibiotics were prescribed.

The authors concluded that broad-spectrum antibiotic prescribing in ambulatory pediatrics is extremely common and frequently inappropriate.

Cough is one of the common reasons for unnecessary antibiotic prescription. As you can see from the diagram below, the differential diagnosis of chronic cough is broad and includes asthma and other conditions in which antibiotics are ineffective:



Differential diagnosis of cough, a simple mnemonic is GREAT BAD CAT TOM. Click here to enlarge the image: (GERD (reflux), Laryngopharyngeal Reflux (LPR), Rhinitis (both allergic and non-allergic) with post-nasal drip (upper airway cough syndrome), Embolism, e.g. PE in adults, Asthma, TB (tuberculosis), Bronchitis, pneumonia, pertussis, Aspiration, e.g foreign body in children, Drugs, e.g. ACE inhibitor, CF in children, Cardiogenic, e.g. mitral stenosis in adults, Achalasia in adults, Thyroid enlargement, e.g. goiter, "Thoughts" (psychogenic), Other causes, Malignancy, e.g. lung cancer in adults).

References:

Antibiotic Prescribing in Ambulatory Pediatrics in the United States. Adam L. Hersh, MD, PhDa, Daniel J. Shapiro, BAb, Andrew T. Pavia, MDa, Samir S. Shah, MD, MSCE. Pediatrics Vol. 128 No. 6 December 1, 2011, pp. 1053 -1061, (doi: 10.1542/peds.2011-1337).

Image source: Wikipedia, GNU Free Documentation License.

Top 10 Most Prescribed Medications

According to a report from the IMS Institute for Healthcare Informatics, the top 10 most-prescribed drugs in the U.S. are:

- hydrocodone (combined with acetaminophen)
- simvastatin
- lisinopril
- levothyroxine sodium
- amlodipine besylate
- omeprazole
- azithromycin
- amoxicillin
- metformin
- hydrochlorothiazide

The top 10 best-selling drugs are:

- Lipitor, $7.2 billion
- Nexium, 6.3 billion
- Plavix
- Advair Diskus, $4.7 billion
- Abilify
- Seroquel
- Singulair, $4.1 billion (it will be generic in 2012)
- Crestor
- Actos
- Epogen

References:
The 10 Most Prescribed Drugs. WebMD.

Image source: Wikipedia, public domain.