ROBERT FRASER, M.D.

Dr. Fraser, you know and I know that any Cub Scout with First Aid training knows you do not treat tetaus with PENICILLIN. So why is it still listed as TREATMENT in the FAQ Health Page Section, to think so is both dangerous and deadly.And certainly misleading to the unknowing lay public. But they are quick to delete "posts" that disagree with their rhetoric. But, ours is not to reason why....

Re: ROBERT FRASER, M.D./Tetanus V Pennicillin

My "Medical" training consists of Advanced Life Support as an EMT and expeirence during combat conditions in the NAvy, one certain thing: If you cut yourself in ANY way, one painful ugly Tetanus shot was on the way. If you were dumb enough to get caught fooling around in Bangkok, a large syringe of Pennicillin was the preventive choice

This is really confusing, I have always been under the impression that there was a specific antigen for Tetanus, and it was not Penicillin. Anytime I have to go the Hospita ER, "HAve you had your Tetanus shot?" I think some clarity is due on this issue. I don't understand how Pennicillin affects a disease that causes tetany of the muscles?

Tom

Dear Dr Hollbrook,

As you know, I stand by my last posting. I just checked and it is still there to be read; not deleted. I was a little disapointed that DR ONE responded to a question about Presidente Beer but did not comment on potential misinformation that they are putting out.

I have copied the CDC piece on tetanus and diphtheria. Hopefully that will put this to rest once and for all!

Tetanus-Diphtheria

Tetanus and diphtheria are serious but distinctly different diseases. Beginning in childhood, vaccination for both tetanus and diphtheria are combined, together with pertussis, into one vaccine. This practice extends into adulthood, when tetanus and diphtheria vaccines usually are administered together, minus the pertussis. The exception is when tetanus vaccine may be given alone as part of wound management.

Tetanus is a severe disease that affects the central nervous system. It occurs in unvaccinated or inadequately vaccinated persons, with adults aged 60 years and older at the highest risk for tetanus and severe disease. Because the reservoirs for the causative agent Clostridium tetani are soil and the intestinal tracts of humans and animals, sanitation workers and those who work outdoors are at increased risk. The mode of transmission is animal-to-human via wounds, including punctures, surgical incisions, and burns. Risk factors for the disease include lack of primary immunization and inappropriate wound care. The incubation period is about 8 days, with a 3-day to 3-week range.

Tetanus vaccine should be routine for all persons, particularly as a part of wound management. Using the combination of tetanus-diphtheria rather than tetanus alone does not increase the rate of adverse reaction.

Diphtheria is an acute respiratory tract infection that is caused by Corynebacterium diphtheriae. There are several forms, including membranous pharyngotonsillar diphtheria, nasal diphtheria, obstructive laryngotracheitis, and cutaneous diphtheria. Diphtheria is rare, but poorly immunized adults are among the most affected populations. The incubation period is 2 to 5 days. Diphtheria outbreaks tend to occur in the fall and winter in temperate regions, but such trends are less distinct in the tropics. The cutaneous form peaks between August and October in the southern United States.

It is estimated that up to 62% of young adults and 84% of those older than age 60 years have inadequate levels of diphtheria antibodies. Thus, careful assessment of patients' immunization records is necessary to ensure proper immunization.

Recommended vaccination for adults with a documented or reliable account of their vaccine schedule is as follows: those who completed the full pediatric series can receive a single midlife booster at age 50 years or older,[4] while those who only received a dose as a teenager or young adult may receive a tetanus-diphtheria booster when they next present and every 10 years thereafter. All persons who did not receive the complete series of tetanus and diphtheria vaccines during childhood, or are not certain of their immunization schedule, should be immunized according to the schedule in Table 3 on page 62.

Re: ROBERT FRASER, M.D./Tetanus V Pennicillin

OK Robert and Dolores, why are you presisiting on disseminating misinformation that could possibly be deadly to the unsuspecting public, i.e. the treatment of tetanus with penicillin. Following a puncture wound there will be those that simply pop a penicillin pill and feel everything will be OK. Everyone makes mistakes but it is incumbant upon you to correct the mistake and set the record straight. Why are you so reticitent? Dolorers, check with your M.D. sister and I am sure she will give you the correct information if you have become unsure of your consultants. I will lay this to rest by asking "where do you get this off the wall information?" No one needs to fear the truth!

ECH: While we are on subjects medical

ECH. Can you give me some further information please. I have read on this board that Imodium is not recommended to take, or Pepto Bismal, the inference being they are in some way not safe. Here in England Imodium is bought over the counter so I thought it was quite safe to take. What is the problem with it please?

Re: ECH: While we are on subjects medical

PEPTO-BISMOL Children who have or are recovering from chicken pox or flu should NOT use this medication to treat nausea or vomiting. Consult a physician because this could be early signs of Reye Syndrome, or something more serious.

IMODIUM There are certain conditions such as patients with acute ulcerative colitis or pssudomembranous colitis that can experience adverse affects and should discontinue the medication.

MY ADVICE IS TO DISCUSS YOUR MEDICATIONS WITH YOUR PHYSICIAN AND YOUR TRAVEL TRIPS AND PLANS AND SEEK HIS ADVICE AS TO ANY ADDITIONAL PRECAUTIONS YOU MAY TAKE TO MAKE YOUR JOURNEY BOTH SAFE AND ENJOYABLE. NATURALLY, HE KNOWS YOUR MEDICAL CONDITION BETTER THAN ANYONE AND IS IN THE UNIQUE POSITION TO GIVE YOU THE VERY BEST ADVICE.

Re: ECH: While we are on subjects medical

Thanks Doc.

A little bit of patience

The discussion of the tetanus booster prior to wound management treatment was only brought up on Saturday. We are checking it out with the medics who we asked to review the health page. We are glad that all concur on the extensive other information presented in the health page. Yes, I have also sent it to my sister (MD in Dallas) for her opinion. I expect to have an answer to post today. Please have a little patience.

From my own experience, in this country patients will receive a tetanus booster if they step on a nail, etc. That is what the resort doctor will most probably recommend. Note that Dominicans do not routinely get tetanus boosters every ten years, although they do get the dpt vaccine in childhood. I recall the exception here is pregnant women.

Our interest is to provide accurate, helpful guidelines for the individual to make intelligent choices. We will double check on the recommendation for post wound management treatment vs. a booster, as well as on the tetanus vs. pennicilin note. We are also adding new information to the page and appreciate the reviews by medical practitioners that are readers of this web site and message board.

Penicillin will prevent tetanus

No where in the Health Page is penicillin listed as a treatment for a person who has contracted tetanus. Dr. Amiro Perez Mera, one of Latin America?s leading experts in Immunology and one of the most respected physicians in the DR, recommends a penicillin shot as a preventive measure, not as a treatment of the disease. We will try to restate the content so it is clear that the penicillin shot should be given immediately after the injury occurs to prevent contracting tetanus.

Dr. Perez reaffirmed in a telephone conversation that the penicillin shot was more effective than a tetanus booster after the wound occurred, because it would kill the biologically active form of the bacillus that could cause the tetanus. He said that a tetanus booster is slower acting and less effective than the penicillin. He explained that the penicillin stops the spore from becoming active upon finding favorable conditions within a deep wound. The object that caused the wound would have had to be infected with animal feces at some point in time, even two years ago.

He also explained that a superficial wound will not produce tetanus, as the bacillus will not survive without air. He explained that a tetanus booster prior to the visit will reactivate the immunological memory. But he feels this is an unnecessary precaution if the person has had the three dpt vaccinations as a child. He stands by the recommendation made in the DR1 Health Page, that it is better to get a penicillin shot afterwars rather than a tetanus booster afterwards. We got back to our pathologist source, Dr. Redondo, who agreed with Dr. Perez Mera?s recommendation and stressed that that area was Dr. Perez area of expertise.

We again list Dr. Perez?s and Dr. Redondo?s credentials again for those concerned with our sources. Dr. Holbrook, please feel free to call Dr. Perez to discuss the matter further with him.

Dr. Amiro P?rez Mera. Dr. Amiro P?rez Mera graduated from the Universidad de Santo Domingo in 1963, with a masters in public health from the School of Tropical Medicine of the University of Puerto Rico, going on to a prestigious local and international career in public health medicine. His extensive curriculum includes the following: Two-time Minister of Public Health of the Dominican Republic. He is nationally and internationally recognized for eradicating polio and yaws sicknesses in the Dominican Republic. He has been guest lecturer and professor at the University of Texas (Austin, Houston and San Antonio), University of Harvard, University South Carolina, John Hopkins University in Baltimore, University of Puerto Rico, and the Institute for Development Studies of Sussex, England, as well as at innumerable medical conferences around the world. He has also been a consultant to the Pan American Health Organization and represented the Americas in the World Health Organization committees and consulted to improve medical systems in Bolivia and Ecuador for the Agency of International Development and the United Nations. He is the founder of the School of Public Health at the UASD in Santo Domingo and has been dean of the School of Medicine of INTEC in Santo Domingo. He is recognized as a national and international authority on tropical medicine, preventive medicine and immunology. He is at present retired but continues to pursue studies in his field. He can be reached at Tel. 809 565-4601

Dr. Yazmin Redondo graduated from the Universidad Nacional Pedro Henriquez Ure?a in Santo Domingo. She carried out post graduate studies in Surgery in New Haven, Connecticut and Pathology at Washington Hospital Center, Washington, D.C. At present she is director of the Pathology Department at the Oncol?gico Heriberto Pieter, the local public health cancer center, in addition to her private practice in pathology. She can be reached at the Oncol?gico at Tel. 685-6681, Ext. 369 or at her practice at 685-7341.