This week’s clinical responsibilities were unfortunately
abbreviated secondary to illness. A learning point from my own case of
bacterial gastroenteritis deals with the antibiotic recommendations that we are
instructed to follow in America. We are told that due to give azithromycin as
Campylobater resistance to fluoroquinolones is 20% in the US and is
likely higher when infections are acquired during travel abroad. However,
physicians in Chiang Mai typically still start with ciprofloxacin for
traveller’s diarrhea initially and may give azithromycin if there is no
clinical response. I had two days of azithromycin treatment
without clinical improvement, but my fever broke 6 hours after
ciprofloxacin. Notably, there were two formulations of ciprofloxacin I
could take which were available at the local pharmacy without need for
prescription. One was cheap, had higher rate of GI side effects, and was less
potent, while the other cost 90 baht a pill (~@$3) and was much more
reliable. My course also drew my attention back to how remarkable
antibiotics are. I think I may have forgotten this fact as we prescribe
them routinely, but my disease was controlled in a matter of hours. They are
such powerful tools when used appropriately. It also harkens back to the
talk I gave the weeks before regarding antibiotic resistance, and how that
prospect is so frightening.
In clinic, I’ve been participating long enough to start
seeing patients for follow-up, which is rather gratifying. One repeat patient
is seropositive with Hep B coinfection, and she came back for follow-up and
vaccinations prior to her leaving for an extended trip in the US. It was
interesting to think about this case from the opposite side of the ocean –
thinking about people traveling to the States as opposed to the VFR that I see
in my continuity clinic back in Minneapolis that are leaving the US for a
period of time.
Working with Dr. Parichat in outpatient clinic, I saw 3 AOID
patients in just one day! This phenomenon is so intriguing. I’m eager to do
more research about it. Apparently it is also prevalent in Taiwan.
This week marks actually marks the end of my infectious
disease exposure at Maharaj Hospital. I start a stint in nephrology next
until I leave for the states. Time is so relative, and just unceasingly
seems to fly forward. It feels like I just arrived here a week or two ago.
Being in this community where Buddhism is so prominent, you could
definitely feel the increased “tone” of mindfulness in the general
population. Hopefully this exposure left a long-lasting imprint that I
will take back with me to the states.
