Series Post: Ask Dr. Dina - Infection Part IV: Treatment

DISCLAIMER: I am not a doctor, nor do I play one on TV. I do not hold a current medical license or certification (I let them lapse because I no longer work in the medical field and don't intend to ever again). What I do have is an extensive medical background in various fields. Everything you read here is the result of either education, training, research and interpretation, or personal experience. The information in this post is not to be taken as a substitute for professional medical advice or examination. Seriously, if you're having an immediate medical problem and you're reading this blog for help, get off the damned computer and call an ambulance! 

ADDITIONAL DISCLAIMER – IF YOU ARE SQUEAMISH/EASILY SQUICKED OUT BY GRAPHIC DESCRIPTIONS OF GROSS THINGS, YOU SHOULD NOT READ THIS POST. THIS ONE IS GOING TO GET…EW. YOU HAVE BEEN WARNED.

PROBABLY SHOULDN'T BE EATING ANYTHING, EITHER.

We've been talking about infection for quite awhile now in our "Ask Dr. Dina" series. This piece was broken into a few parts because there are many, many different types of infection and I wasn't about to write a book on the subject.

These parts were –

I – Bacterial
II – Viral
III – Fungal

Now we've come to the final installment of this piece – Part IV: Treatment. In this piece I'm going to talk about…you guessed it…the different ways to treat various infections.

Let's start with something everyone (hopefully!) does – cleaning. Cleaning the things that touch the infection is just as important as cleaning the infected area itself.

Killing microbes (commonly called "germs") on something is called "sterilizing." You're making something free of contaminants – making it sterile. There are lots of ways to sterilize things, but I'll only talk about a couple here. Hospitals and other places like laboratories and tattoo parlors use a machine called an autoclave to sterilize their equipment using high heat and pressure. Ever see a movie where they take a lighter or candle and run the flame over a blade or pointy object before sticking it into someone? Same principle (and it works, but you have to do it more than a few times to get the thing sterile).

You know those little bleach wipes you can get for the kitchen and bathroom? Those are awesome! Bleach kills a hell of a lot of things, and you don't need much to do it, either. A 10% solution of bleach mixed with water is enough to kill the HIV virus, tuberculosis, hepatitis and other bloodborne/bodily fluid pathogens.

(Here's a link for the technical medical types from the CDC. Warning: unless you speak Science, this is going to hurt your brain: http://www.cdc.gov/hicpac/disinfection_sterilization/3_2contaminateddevices.html )

Alcohol is another good thing to use to sterilize something. We've all seen movies where a character is injured and someone pours vodka over the wound and the character screams. Yeah, that's about right. It's going to hurt like a bitch to do that. They also pour some over the knife before they begin cutting into the character. Why? To sterilize it! Booze does work if you've got nothing else (the "better than nothing" principle), but there's a lot of other things in booze that aren't so lovely for sterilizing. And it has to be spirits, not beer or wine. Neither beer nor wine have a high enough alcohol content to do anything but wet the wound, make it smell funny, and possibly infect it with some kind of fermenty thing. Best use the beer and wine to get the character intoxicated so they don't whine when you clean their wound with something else. (Note: sarcasm. Alcohol dehydrates you despite it being liquid and shouldn't be given to wounded people. It looks cool, though.) We'll talk more about wound care in another post.

Do you carry a little bottle of sanitizing hand gel (I do!)? If you do, you should make sure it has an alcohol content of at least 60% in order to be effective at killing microbes on your hands. Now this will burn like fire if you get it in an open wound or your eyes, so try not to do that. If you've got a paper cut you're not aware of, I guarantee you the hand gel will tell you all about it. Nothing beats soap, water, and friction (friction is most important believe it or not) for washing your hands (which you should do often, by the way, especially if you touch your face/hair/nose or have small humans in the house), but in a pinch/if those things aren't accessible, hand sanitizer will do.

But all that's just surface stuff. Inanimate objects (called "fomites" in the fancy medical speak) need to be cleaned in order to keep the potential for infection at a minimum. It won't to any good to wash your infected wound in a dirty sink, now will it?

Now that we've talked about cleaning things (treatment!) outside the body, let's talk about how to treat infections on or inside it. Following the order of the previous posts, let's start with bacterial infections.

These are the most common infections, and as we know the most about them, are the easiest to treat. Bacteria are easier to kill than other microbial life for a lot of reasons I'm not going to get into.

I mentioned in the post on bacterial infection that antibiotics are for killing bacteria, not viruses. Now, not every infection needs antibiotics. When your cat scratches you and you get a little red line that gets puffy and stingy for a couple days, yeah, that's likely infected, but it will most likely go away on its own. Your body's natural infection control – your immune system – has that covered. The bouncers will show up and throw the assholes out and send a repair team in to fix the damage Kitty inflicted. It will take a few days, but they'll sort it out. It's when there's more work than your immune system can handle that it needs some help in the form of antibiotics.

Antibiotics come in all sorts of forms. They come in creams and ointments you spread on/in the wound, liquids you pour into the infected area, pills you swallow, and injectables you either shoot directly into the muscle, under the skin, or into a vein through an intravenous line (IV). It just depends on the type of infection you have and where it's located. Most antibiotics aren't over-the-counter except for some creams and ointments (we've all used a triple-antibiotic ointment for a cut or scrape, I'm sure), so if you feel you need an antibiotic for whatever reason, go see your doctor for a prescription. They'll determine if you actually need one. Overprescribing antibiotics is a problem as the things they're trying to kill with them develop resistance to them, which is why if the doctor determines you have a cold VIRUS instead of a bacterial sinus infection, you're (hopefully/probably/most likely) going to be told to go home, take some acetaminophen, drink lots of fluids, and rest.

Which brings us to viruses. As said both above and in the post about bacterial, antibiotics DON'T WORK ON VIRUSES. What does? Well…not a whole lot. There are some antivirals out there, but they're not designed to kill the virus they're treating. They're designed to make it hard for the virus to grow/develop. Not only that, but antivirals are target-specific. You may have heard the term "broad-spectrum antibiotic." What this means is that that antibiotic will kill a whole host of different types of bacteria. Not so with antivirals. There aren't many, and the ones that are out there are for viral infections like HIV or herpes.

Now, as I said above, there are things that kill viruses outside the body, like bleach and other substances, but that's not really a treatment. There are some vaccines against certain viruses (like polio) that are very effective, and some that aren't (like influenza). Medicine continues to search for vaccines for things, but viruses are hard to beat. Prevention is the best medicine for viral infections, because treatment is a complete bitch.

Fungi are also hard to treat, mostly because the duration is so long AND because the little bastards are hard to completely eradicate. Fungi have the unique ability to propagate themselves in almost any environment with only a single spore. They're hardy and like extremes, and even when you think you have it beat, it JUST. WON'T. DIE.

But! They are easier to treat than viruses. Not as easy as bacteria, but we do have ways to deal with them. If you've ever had a cream or other drug that ended in "–zole," you've likely been given an antifungal (or antiparasitic, which I'll toss in here because that's what I did in the post on fungal infections). There are a whole lot more antifungals out there, and all of them work almost exactly like antibiotics – attacking the fungi itself in order to allow your immune system to get a kill strike. Some work like antivirals, and keep the infection from getting anywhere until your immune system has a chance to raise shields and keep it from getting in. Like antibiotics, antifungals come in all different forms (and are often mistakenly called "antibiotics" by health care professionals and laymen alike) with varying degrees of efficacy. Depending on the severity of the infection, an over-the-counter seven-day yeast infection treatment might not work as well as a stronger one prescribed by a doctor. It's the same medication, really, just in a different formula with a more powerful delivery system.

(NOTE: This isn't to say that you should get more of the OTC treatment and use it doubled, because THIS WILL NOT WORK LIKE A PRESCRIPTION. The prescription version is different from OTC for a reason. While most OTC versions work just fine, if you need a prescription version, OTC isn't going to help you. NEVER DOUBLE UP ON OTC DOSAGES OF ANYTHING. "MORE" IS NEVER "BETTER.")

Now, how does all this apply to your character? Well, I'll leave that to you. I've given you post after post as to how infections happen, and now I've told you how they're treated. If you've got a character with a gunshot wound (GSW in the fancy medical speak) and you have them in the back of a car speeding down the street, infection should be the last thing on your mind. Later on, if you have them in a quiet spot, you can have them assess the damage and what to do about it. Hopefully these posts on infection will help you consider the details, like how they're going to sterilize something in that situation (or even if you're going to have them do it).

This concludes the Infection Sequence of the Ask Dr. Dina series. Next time we'll talk about something less gross. Like drowning.

Questions about medical issues with your writing? Leave them in the comments below and I'll get back to you as soon as I can. (THESE MUST APPLY TO FICTIONAL SITUATIONS ONLY. I AM NOT YOUR DOCTOR, NOR A SUBSTITUTE FOR ONE.)