Dr. Phil MohlerMOHLER'S MEDICATION MAXIMSGrand Junction Free Press Health & Wellness Columnist

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January 3, 2013
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MOHLER: Beware the medication cascade: A true story!

Frank is a 37-year-old accountant with a bad sore throat. His Strep test is negative. His physician, Ira Goodfella, recommends Tylenol and salt water gargles. Frank insists that he never gets well without antibiotics. Dr. Ira caves to Frank's wishes and writes him a prescription for an antibiotic.Four days later, Frank's sore throat is gone (in spite of, not because of the antibiotic), but he now has severe diarrhea (common side effect of the antibiotic). He again visits Dr. Ira, who finds Frank in some distress, but with a soft belly and not dehydrated. Dr. Ira prescribes Lomotil, a medicine to block Frank's diarrhea.Frank's diarrhea improves quickly over the next 24 hours, but then his belly becomes very distended, hard and painful. He is hospitalized with a bowel obstruction (the Lomotil put his bowel to sleep). Three days and several thousand dollars poorer, Frank is discharged home, the victim of the medication cascade. Sore throat (useless antibiotic) = diarrhea (Lomotil) = bowel obstruction.

Physicians sometimes inappropriately prescribe antibiotics.Physicians always want to please their patients.Take Home Message: As a patient, be careful what you ask of your physician.In this clinical story, it is extremely unlikely (1 chance in a 100) that the antibiotic would help Frank's sore throat. It was much more likely (1 chance in 6 or 8) that Frank would get diarrhea from the antibiotic.Take Home Message: ALL drugs have side effects. Before you start any new medicine, have the downsides vs. upsides discussion with your physician. Many times, the best medicine is no medicine at all.Dr. Mohler has practiced family medicine in Grand Junction for 38 years. He has a particular interest in pharmaceutical education. Phil works part-time for both Primary Care Partners and Rocky Mountain Health Plans.


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The Post Independent Updated Jan 3, 2013 02:51PM Published Jan 3, 2013 02:50PM Copyright 2013 The Post Independent. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.