Medical negligence often occurs as a result of omissions, such as failure to order appropriate tests leading to a misdiagnosis. Other claims arise as a result of affirmative acts of negligence, such as ordering the wrong treatment after the correct diagnosis is made. One of the most frightening examples of the latter is when a doctor prescribes medicines that are not needed (including antibiotics) and the patient develops a severe allergic reaction to the drug, resulting in conditions known as Stevens-Johnson Syndrome (SJS) and/or toxic epidermal necrolysis (TEN). These conditions involve rapid deterioration and death of mucous membranes and skin. SJS/TEN often occur together.
There are a number of medications implicated in causing SJS/TEN, including various antibiotics, some barbiturates (e.g., Seconal, Phenobarbital), Allopurinol (gout medicine), Levaquin, Diclofenac, Accutane, Bextra, Januvia, Tamiflu, Dilantin, Trileptal, Alertec, Lamictal, Ibuprofen, Tegretol, Wellbutrin, Nystatin and others. When the use of the drug is elective, the prescribing physician must explain the risks of taking it, including the risk of SJS/TEN. Failure to do so may give rise to a claim for lack of consent or medical malpractice. Likewise, if the drug is not indicated or is given by accident (e.g., a pharmacy mistake), a claim for medical malpractice may arise.
Antibiotics Addressed by CDC
Antibiotics are frequently overprescribed by physicians. This year, antibiotic misuse was addressed in part by the American College of Physicians and the Centers for Disease Control (CDC) in guidelines published on antibiotic use for respiratory tract infections. The recommendations include the following:
- Bronchitis: Doctors shouldn’t prescribe antibiotics unless they suspect pneumonia.
- Group A streptococcal pharyngitis: Doctors prescribe antibiotics only after a positive antigen detection test and/or culture for group A Streptococcus in symptomatic patients.
- Acute rhinosinusitis: Doctors should prescribe antibiotics only in patients with symptoms that have lasted over 10 days; with severe symptom onset or high fever and purulent nasal discharge or facial pain that has lasted for 3 days or more; or with worsening symptoms after a viral illness that was improving.
- Common cold: Doctors shouldn’t prescribe antibiotics.
As medical lawyers handling medical negligence claims in Ohio, the first question to ask when a patient develops SJS/TEN is whether the inciting medication was necessary.
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