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  1. #41
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    Quote Originally Posted by shelterbuilder View Post
    I'm not a doctor, but I would think that taking ONE doxy (or one of any antibiotic) would be a waste of a good antibiotic, unless, of course, you were trying to create a superbug that was immune to that antibiotic! Antibiotics are generally prescribed as a course that runs 7 to 10 days, so that all of the offending bug that's in your system is killed off. I have my doubts that one dose would be enough to do this.
    Actually I attended the medical discussion at the Gathering (Dr Gwinn presiding) and if I recall correctly he said he carries doxy on his as a Lyme's prevention. He recommended 1-2 pills (immediately or within a week or so) after getting a tick bite. The theory being that this would be enough to kill any Lyme bug during its incubation period and prevent it from becoming full-blown Lyme's. (Don't take this as gospel -- this is from memory which could be fuzzy.)

    I kinda wish I'd thought to bring up MRSA at the discussion.
    "when the going gets weird, the weird turn pro." --HST
    Uncle Silly VA->VT '05, VT->ME '07, VA->GA ??

  2. #42
    Registered User shelterbuilder's Avatar
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    Quote Originally Posted by Uncle Silly View Post
    Actually I attended the medical discussion at the Gathering (Dr Gwinn presiding) and if I recall correctly he said he carries doxy on his as a Lyme's prevention. He recommended 1-2 pills (immediately or within a week or so) after getting a tick bite. The theory being that this would be enough to kill any Lyme bug during its incubation period and prevent it from becoming full-blown Lyme's. (Don't take this as gospel -- this is from memory which could be fuzzy.)

    I kinda wish I'd thought to bring up MRSA at the discussion.
    As I said, I'm no doctor...the last time I was diagnosed with Lyme, my doc prescribed a 3 week doxy course (this was 6 - 7 years ago). One or two pills strikes me as kind of "living on the edge".

    From what I'm reading, MRSA's been around for a while, but it's only recently that it's getting it's "fifteen minutes of fame" in the media. I guess that the media needs to take some of the spotlight off of global warming, with the presidential elections coming next year.

  3. #43

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    Quote Originally Posted by Uncle Silly View Post
    Actually I attended the medical discussion at the Gathering (Dr Gwinn presiding) and if I recall correctly he said he carries doxy on his as a Lyme's prevention. He recommended 1-2 pills (immediately or within a week or so) after getting a tick bite. The theory being that this would be enough to kill any Lyme bug during its incubation period and prevent it from becoming full-blown Lyme's. (Don't take this as gospel -- this is from memory which could be fuzzy.)

    I kinda wish I'd thought to bring up MRSA at the discussion.

    I hope your memory is fuzzy because that is very poor advice and that physician should be ashamed if he actually said something like that. Prophylaxis is not recommended at all for tick bites and if you have early Lyme disease, you need ten days of doxy, not one or two doses.

    http://www.journals.uchicago.edu/CID...000342.web.pdf

    MRSA and Lyme are serious medical problems. The medical and other health care professions at least make a pretense of adhering to scientific principles. It is very easy to Google and find reliable resources and information.

    For the most part, there is little room for speculation and opinion because there is scientific evidence to support practices involved in the prevention, diagnosis, and treatment of disease. Spreading sensational headlines or inaccurate information like "MRSA is running rampant on the A.T." or other inaccurate information about such issues is extremely irresponsible.

  4. #44

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    Quote Originally Posted by shelterbuilder View Post
    As I said, I'm no doctor...the last time I was diagnosed with Lyme, my doc prescribed a 3 week doxy course (this was 6 - 7 years ago). One or two pills strikes me as kind of "living on the edge".

    From what I'm reading, MRSA's been around for a while, but it's only recently that it's getting it's "fifteen minutes of fame" in the media. I guess that the media needs to take some of the spotlight off of global warming, with the presidential elections coming next year.
    EXACTLY!!!

  5. #45
    Registered User greengoat's Avatar
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    Many of my peers at Ranger School contracted staff. I remember cuts and abrasions oozing with puss. Those of us who treated our abrasions and cuts with Hydrogen Peroxide and neosporin, from the beginning, on a daily basis did not contract staff. Hygeine works even on the AT! Wet Ones work great for a makeshift sponge bath before racking out. Plus it helps cut down the stink. Loose the underwear except for microlight merino wool in cold weather and you'll be fine.

    Vty
    Green Goat

  6. #46

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    Subject: DOHMH Alert # 33 - Methicillin resistant Staphylococcus aureus infections in school aged children
    Date: October 31, 2007 11:48:29 AM EDT

    Dear HAN Subscriber:

    We have just released a DOHMH Alert concerning Methicillin resistant
    Staphylococcus aureus infections in school aged children.

    2007 Alert 33:
    Methicillin resistant Staphylococcus aureus infections in school aged
    children

    Community-acquired methicillin-resistant Staphylococcus aureus (MRSA)
    skin infections in children are common. Serious illness and deaths are
    extremely rare.
    Single cases of MRSA are not reportable. Please report clusters or
    cases in which an increased risk of person-to-person transmission exists
    (see text for details).

    Please Distribute to All Clinical Staff in Internal Medicine, Surgery,
    Pediatrics, Infectious Diseases, Emergency Medicine, Family Medicine,
    Dermatology, Laboratory Medicine and Infection Control Staff. Please
    also share with your non-hospital based primary care colleagues.

    October 31, 2007

    Dear Colleagues,

    The recent death of a12-year-old child in Brooklyn has raised community
    concern over methicillin-resistant Staphylococcus aureus (MRSA)
    infections occurring in school aged children. Although the Medical
    Examiner is still investigating the exact cause of death, a blood
    culture obtained 24 hours postmortem grew MRSA. The child was known to
    have had a recent skin infection. There have been no secondary MRSA
    infections associated with this case. The purpose of this alert is to
    inform primary and acute care practitioners about community-acquired
    MRSA infections, offer guidance in diagnosing and treating MRSA
    infections, and to clarify reporting requirements to the NYC Department
    of Health and Mental Hygiene (DOHMH).

    Skin and soft tissue infections (SSTIs) in children are common and
    approximately half are due to Staphylococcus aureus. A study published
    this month reported data from nine sentinel active surveillance sites
    (Klevens et al. Invasive methicillin-resistant Staphylococcus aureus
    infections in the US. JAMA 2007; 298:1763-71). The study was limited to
    bloodstream and other sterile site MRSA infections and therefore does
    not include uncomplicated SSTIs. The authors estimated that 94,360
    invasive MRSA cases occur in the US annually, more than were previously
    believed to occur. MRSA is currently reportable in only a handful of
    states and the true incidence of MRSA, inclusive of skin and soft tissue
    infections, is unknown.

    The recent media attention given to this common pediatric infection may
    cause parents to bring children to their physician requesting
    examination, screening and reassurance. DOHMH conducted a survey of
    laboratories with high-volume pediatric hospital emergency departments
    in NYC to estimate the number of MRSA SSTIs in children. We estimate
    that there were at least 600 laboratory-confirmed MRSA cases in children
    5- to 18-years old in NYC in 2006. During the same time period, no
    deaths due to MRSA in previously well children were found on a
    preliminary review of death certificates for NYC children less than 18
    years of age. Clinicians should reassure parents that while skin and
    soft tissue infections are common in children, serious illness is very
    unusual. In the article by Klevens referenced above, the death rate
    among children was reported as 0.1 per 100,000 population, and the rate
    of invasive infection (positive culture from a sterile site) was 1.4 per
    100,000 among 5- to 17-year-old children.
    Transmission of MRSA is generally by direct person-to-person contact.
    The role of fomites or contamination of the environment in community
    transmission is believed to be minimal. We recommend that all exposed
    wounds, especially those with draining exudate or pus, be securely
    covered with a clean, dry bandage in public settings.

    Management of MRSA Infections in School-aged Children
    MRSA in school-aged children is common and covered wounds present little
    or no risk of transmission. Children with MRSA should not be excluded
    from school. MRSA outbreaks or clusters in classroom settings have not
    been reported. However, outbreaks among members of sports teams,
    especially those with a high degree of skin to skin contact, have been
    reported.

    Individuals involved in contact sports (e.g., football, basketball,
    wrestling) should have skin and soft tissue injuries regularly viewed by
    parents, coaches or trainers to assure the injuries are healing
    normally. Any sign of infection should be promptly evaluated by a
    medical provider. Because of the nature of the sport, wrestlers with
    MRSA should not be allowed to participate until their wound has healed
    and the patient has received medical clearance. Athletes diagnosed with
    MRSA, other than wrestlers, should be evaluated on a case-by-case basis
    and excluded from participation only if their wounds cannot be securely
    covered to prevent leakage of drainage. Care should be taken to ensure
    that any equipment, towels or clothing which may have contact with the
    wound are not shared.
    Please reinforce with your patients that frequent hand washing and
    personal hygiene are fundamental to preventing MRSA infections.

    Diagnosis and Treatment of SSTI
    Incision and drainage (I&D) is the preferred treatment for abscesses
    whenever possible. Practitioners who are not able to perform I&D in
    their offices should assess the need for the procedure and refer the
    patient to either a surgeon or an emergency department where the
    procedure can be performed. Antibiotic treatment often is not necessary
    and the patient should be educated on general wound care. However,
    culture of the wound or abscess should be strongly considered,
    particularly if antibiotic treatment is given, the initial regimen has
    failed, or the infection appears to be severe. Antibiotic therapy should
    be guided by culture and susceptibility results. As these tests take
    several days, empiric therapy should consider that MRSA is increasingly
    recognized in community settings; data from an ongoing DOHMH
    investigation found that 39% of Staphylococcus aureus identified in
    cultures submitted to a large commercial outpatient laboratory in 2006
    were methicillin-resistant. The sample includes patients of all ages and
    represents patients visiting private medical providers. The Table below
    presents the susceptibility profile of these isolates to commonly used
    antibiotics. A review article on the clinical approach to MRSA SSTI was
    published this summer in the New England Journal of Medicine (Daum S.
    Skin and soft tissue infections caused by methicillin-resistant
    Staphylococcus aureus. N Engl J Med 2007; 357:380-390).

    Colonization by Staphylococcus aureus may occur in 20-25% of healthy
    people; fewer than 1% are colonized by MRSA. Treatment of colonization
    is not generally recommended as carriage may be transient. Unless a
    patient has recurrent MRSA infections there is no indication for routine
    nasal screening. Consultation with an infectious disease specialist
    before treating colonization is recommended.

    MRSA pneumonia is a well-known and potentially fatal complication of
    influenza infection, including in children. Consider influenza vaccine
    for your patients at increased risk for influenza-related morbidity and
    mortality. There is no shortage of vaccine this year. The following
    pediatric groups should be targeted for influenza vaccination:
    All children 6 months to 5 years.
    All persons 6 months and older with chronic medical conditions,
    including heart disease, pulmonary disorders (including asthma),
    diabetes, kidney disease, hemoglobinopathies and compromised immune
    systems (HIV or immunosuppressive therapy).

    For more information on indications for influenza vaccine please visit:
    http://www.nyc.gov/html/doh/html/imm/fluhome.shtml

    Environmental Cleaning Considerations for MRSA
    No special disinfection measures are recommended for schools or offices
    to eliminate Staphylococcus aureus or MRSA from the environment. Humans
    are the natural reservoir and the organism is ubiquitous. Proper skin
    care and personal hygiene are the recommended measures to control MRSA
    in non-healthcare settings. Specific guidance on EPA-registered
    disinfectants effective against MRSA is available at:
    http://www.epa.gov/oppad001/list_h_mrsa_vre.pdf

    Reporting of MRSA
    Please report clusters of MRSA (2 or more confirmed cases with a common
    association) to DOHMH. Single confirmed cases of Staphylococcus aureus
    and MRSA are not reportable except under the following high-risk
    categories:
    . Children and young adults involved in inter-scholastic,
    inter-collegiate and competitive sports teams where either shared
    equipment or use of locker room facilities exists.
    . Children in daycare.
    . Persons living in congregate settings (e.g., shelters).
    . Any unusual circumstances in which wound drainage cannot be contained
    or a risk of contamination to others exists.
    . Any unusual manifestation of disease (e.g., death in a child).

    The Department has proposed adding MRSA to the list of reportable
    diseases. We are only asking that laboratories be required to report
    MRSA through the New York State Electronic Clinical Laboratory Reporting
    System. Medical providers are not being asked to report individual MRSA
    cases except, as noted above, clusters or individual cases with high
    risk for exposure to others. MRSA reporting will assist the Department
    to quantify the burden of illness in NYC, track trends, perform
    investigations to learn about risk factors and develop prevention
    messages. A proposal was submitted to the Board of Health on October 24,
    2007 and is presently open for public comment until November 28, 2007.

    For more information or to comment on the proposal, please visit our
    website at:
    http://www.nyc.gov/html/doh/html/notice/notice.shtml


    Table- Antibiotic susceptibility profile of community and
    healthcare-associated MRSA from skin and soft tissue infections
    diagnosed by a commercial outpatient laboratory, all ages, NYC, 2006
    Antibiotic Percent Susceptible

    Healthcare associated-MRSA (%)
    (Healthcare exposure defined as hospitalization, surgery or dialysis in
    the 3 months prior to onset of infection)
    N=105 Community associated-MRSA (%)
    (Patients without healthcare exposure)
    N=567
    Ciprofloxacin 21 30
    Clindamycin1 43 62
    Erythromycin 12 11
    Tetracycline 90 82
    Trimethoprim-Sulfamethoxazole 99 99
    1 Clinicians should check with their laboratories to ensure that the
    D-test to examine for inducible clindamycin resistance is performed


    Additional information may be found at the Centers for Disease Control
    and Prevention website:
    http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca.html

    The CDC, American Medical Association, and Infectious Diseases Society
    of America flyer on clinical management of skin and soft tissue
    infections:
    http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_skin.html

    Strategies for Clinical Management of MRSA in the Community, the summary
    of an expert panel convened by CDC is available at:
    http://www.cdc.gov/ncidod/dhqp/pdf/a...Strategies.pdf

    CDC's Get Smart Campaign Promoting the Judicious Use of Antibiotics
    http://www.cdc.gov/drugresistance/community/

    To report a cluster or confirmed high-transmission risk MRSA case,
    consult on infection control practices, or to obtain additional
    information, please contact the Bureau of Communicable Disease at:

    During business hours: 212-788-9830
    After hours, contact the Poison Control Center: 212-764-7667 or
    1-800-222-1222 and ask for the Doctor on Call

    We appreciate your assistance in addressing the emerging problem of
    community acquired MRSA in New York City.

    Sincerely,

    Don Weiss, MD, MPH
    Director of Surveillance
    Bureau of Communicable Disease

    Melissa A. Marx, PhD
    Director, Antibiotic Resistance Unit
    Bureau of Communicable Disease

  7. #47
    Donating Member Cuffs's Avatar
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    Quote Originally Posted by rem1536 View Post
    That is ignorant. Sanitation is at its worst on the trail. That's why a greater percent of people that hike the trail come away with it. You are more likely to get MRSA on the trail than if you live a normal existence.
    OK, no name calling please. I will say that when I was teaching, I had every cold that came thru the classroom, so much for sanitation. I always got better and felt better when out hiking. I do keep a strict hygiene regiment on the trail.

    Where are you rpercentages coming from? What database provided your statistics?
    ~If you cant do it with one bullet, dont do it at all.
    ~Well behaved women rarely make history.

  8. #48
    Registered User kyerger's Avatar
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    I hiked that section then too. Went fron Ga./NC boarder to the smokies. i had no problems with MERSA. Any chance we ran into each other. I go by trail name turdle cause im slow.

  9. #49

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    Quote Originally Posted by Appalachian Tater View Post
    Spreading sensational headlines or inaccurate information like "MRSA is running rampant on the A.T." or other inaccurate information about such issues is extremely irresponsible.
    Truer words have never been spoken on this forum. For some perverted reason many people love to spread fear. For them, I always say, please stay under your bed and do not type.

  10. #50

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    Quote Originally Posted by rem1536 View Post
    You are more likely to get MRSA on the trail than if you live a normal existence.
    This is possibly the biggest load of BS on this forum. There are fewer people on the trail than almost any place else in this country. Do you get MRSA from trees? Again stay under your bed and stop spreading fear.

  11. #51
    First Sergeant SGT Rock's Avatar
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    I hear if you filter your water you are immune.
    SGT Rock
    http://hikinghq.net

    My 2008 Trail Journal of the BMT/AT

    BMT Thru-Hikers' Guide
    -----------------------------------------

    NO SNIVELING

  12. #52

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    Yeah but you have to carry hiking poles and sleep in a shelter at least 2x a week.

  13. #53
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    I heard you can get MRSA from trees, even if you filter your water!
    "when the going gets weird, the weird turn pro." --HST
    Uncle Silly VA->VT '05, VT->ME '07, VA->GA ??

  14. #54
    Registered User shelterbuilder's Avatar
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    Thank you, Tater, for that post - a little long-winded, but right on the mark for putting this issue to rest scientifically.

    It seems to me that most of us have a better chance of coming down with Lyme than we do of contracting MRSA.

    (So tell me, where's the "panic thread" for Lyme? )

  15. #55

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    Uncle Silly is correct about a single 100mg tab of Doxycycline being preventative for Lyme disease. This is not a treatment for an infection, there is no infection...yet. You find tick, remove tick, take pill, all is well. If you wait a week, all bets are off.

    You only take one pill per week to prevent malaria (unless you are using doxy, then you take one pill daily). If you get malaria, you must take lots and lots of pills.

  16. #56
    First Sergeant SGT Rock's Avatar
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    Where does one get Doxycyckine?
    SGT Rock
    http://hikinghq.net

    My 2008 Trail Journal of the BMT/AT

    BMT Thru-Hikers' Guide
    -----------------------------------------

    NO SNIVELING

  17. #57
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    Quote Originally Posted by SGT Rock View Post
    Where does one get Doxycyckine?
    Ask your doctor for it. Worked for me.

  18. #58
    Registered User shelterbuilder's Avatar
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    Quote Originally Posted by take-a-knee View Post
    Uncle Silly is correct about a single 100mg tab of Doxycycline being preventative for Lyme disease. This is not a treatment for an infection, there is no infection...yet. You find tick, remove tick, take pill, all is well. If you wait a week, all bets are off.

    You only take one pill per week to prevent malaria (unless you are using doxy, then you take one pill daily). If you get malaria, you must take lots and lots of pills.
    I still have problems with the concept of taking only one antibiotic pill at any stage of infection. To my way of thinking - and correct me if I'm wrong - low doses of antibiotics are how we create "superbugs" in the first place, by accustoming the bugs to low doses of the drugs we use to kill them.

    SGT, doxycycline is a tetracycline analog, available by prescription only.

  19. #59
    First Sergeant SGT Rock's Avatar
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    Quote Originally Posted by _terrapin_ View Post
    Ask your doctor for it. Worked for me.
    Quote Originally Posted by shelterbuilder View Post
    I still have problems with the concept of taking only one antibiotic pill at any stage of infection. To my way of thinking - and correct me if I'm wrong - low doses of antibiotics are how we create "superbugs" in the first place, by accustoming the bugs to low doses of the drugs we use to kill them.

    SGT, doxycycline is a tetracycline analog, available by prescription only.
    So this is a pill or two you carry in case you get a tick.

    Of all the critters out there, the Lyme disease is the one I really am concerned about. Too bad the vaccine was a flop.
    SGT Rock
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    My 2008 Trail Journal of the BMT/AT

    BMT Thru-Hikers' Guide
    -----------------------------------------

    NO SNIVELING

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    Rock, you need a scrip for doxycycline. 100mg is the usual dose. It comes in tablets and capsules, the tablets store much better. When you get this stuff it needs to go in an airtight container with a little dry cotton and stored at room temp or below. Write the expiration date on it, and try to get some with the farthest out exp date. I have used penicillin based drugs that were years out of date with no problem. Don't even think about trying this with doxy or anything else in the tetracycline family as it decays into products that are really, really hard on your kidneys. When the drug expires, replace it and throw the old stuff in the trash.

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