A retired teacher recently presented with nontender quarter sized minimally red blotch on her leg. She told of recent treatment for a skin infection at an ED. She had no drainage to culture so was treated empirically with a cephalosporin, the infection rapidly diminishing but she soon stopped the med due to GI side effects leaving this minimal lesion. A few days later she came to my office, seeking further treatment.
Mrs. Surfer:I want linezolid for this. The Internet says it is The Drug Of Choice for skin infections.
Dr. Dall: It's used for severe, dangerous infections with possibly resistant staph. We try to hold it in reserve so we don't breed resistance.
Mrs. Surfer: I want the best medicine, it is what is recommended.
Dr. Dall: I'm not going to give it to you. Your infection is minor, non-threatening, and responded to an ordinary antibiotic and is essentially gone. You don't need a horrendously expensive IV medicine.
Mrs. Surfer:I want the best medicine, I don't care about the cost. I can pay for it if my insurance does not.
Dr. Dall: I'm not going to give it to you, I reserve it for specific circumstances.
Mrs. Surfer:Could you give me IV penicillin then? I won't take anything oral.