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Guest post: Antimicrobial stewardship: "We must act now to protect future generations"

40 replies

MumsnetGuestPosts · 25/08/2015 16:45

Consider this scenario. Your child has been awake all night, crying with earache. They're upset and tired, and so are you. You had a flu bug last week, and took some of the antibiotics left over from when your husband had a sore throat a couple of months ago. You'll take the little one to the doctor in the morning and get antibiotics to clear it up. You'll probably have to pester the GP for them, but you'll do it so your child feels better quickly and you don't all have another sleepless night.

In the morning, while you're rushing to the surgery, your dad calls. Your mum's in hospital having a hip replacement, but she's picked up an infection and the antibiotics they're using to treat it aren't working. The doctors will need to try a different antibiotic.

It's probably not immediately apparent to you, but insisting on antibiotics for your child and taking a relative or friend's leftover antibiotics may have an indirect impact on patients such as your mum.

Last week, NICE released their guidelines on antimicrobial stewardship, but what will they mean for parents of children suffering from common infections?

As recently as the 1930s, people often died from infections such as pneumonia or meningitis. Routine operations were high-risk due to the chance of wound infections. Antibiotics, hailed as wonder drugs, changed that and treating and preventing infections became part of modern medical practice. But the bacteria began to fight back, becoming resistant to antibiotics – and our widespread use of antibiotics is partly to blame.

Many of us take antibiotics that we don't need. Antibiotics don't work for colds and flu, they aren't required for most coughs or sore throats, but still we ask for them. And once we have them, we don't always take them in the way we should: missing doses, not finishing the course, and saving them for future use. The idea that this might mean antibiotics won't work in future may sound alarmist, but it's a very real possibility. If we continue as we are doing, common infections will become untreatable and preventing infections during routine healthcare such as setting broken bones, caesarean sections and chemotherapy will not be possible. It's happening already in some parts of the world. But if we look after antibiotics now, and make sure we only use them when we really need to, then they will continue to work.

It needs to be known that antibiotics do not work for most coughs, sore throats and earaches. These are usually self-limiting infections, so the body can fight them itself. Simple self-care measures such as taking some rest, drinking plenty of fluids and regular paracetamol or ibuprofen for a few days will help you or your child feel better. Your local community pharmacist will be able to advise you on when you should see a doctor, as well as symptom relief.

We have grown used to a consumer society in which the customer is always right – but don't expect your GP to prescribe antibiotics when they aren't needed. You may feel desperate to make your child feel well again, but antibiotics aren't necessarily the answer. Antibiotics commonly have side effects such as tummy upsets and have been shown to only reduce the length of time you have symptoms by one day at the most. The inappropriate use of antibiotics may also allow the bacteria to become resistant, causing future problems both for the individual and the wider population.

In some cases, antibiotics will be required. So if your doctor does prescribe an antibiotic for you or your child, always take them as directed – the right amount, at the right time, for the right duration. Never save them for future use or share them with others and return any unused antibiotics to your local community pharmacy for disposal.

Healthcare providers and healthcare staff need to change their practices to preserve our antibiotics but patients and the public also have an important role to play. When your child is crying with earache, your partner is complaining of a sore throat or you're lying in bed with flu, your actions could have a huge potential cost for future generations. By not reaching for antibiotics every time, you're helping safeguard these wonder drugs for your children and their children.

OP posts:
LeChien · 25/08/2015 18:52

Whilst obviously some people are stupid enough to have leftover antibiotics and use them at other times inappropriately, surely there needs to be more onus on drs refusing to prescribe them?

My SIL is proud that she can sit in the dr's office and refuse to move until he's given her antibiotics for the sore throat that she woke up with that morning, but she shouldn't be given any power in that decision, she doesn't hold a medical degree. Perhaps a placebo called Shamoxycillin should be prescribed for people who beg for them without evidence that they are necessary!

Every time recently I have seen a gp for my dc, they have routinely been offered antibiotics. When I've asked if they need them, I'm usually told no, but that prescribing them reassures parents, so they usually offer them. How many parents are likely to refuse under those circumstances?

Labels are often ambiguous. Ds2 had a nasty ear infection which he received antibiotics for. The label said "10 mls to be taken 3 times a day. Always finish the course". Ds1 got to day 3, felt 100% better so for him, the course was finished. I had to battle to get him to carry on taking it.
Had the label clearly said For 5 days, then throw the rest away, ds would have known.

I also wonder how much farming contributes to this, and what measures are being taken in global agriculture to reduce routine antibiotic use?

microferret · 25/08/2015 18:56

This is of course very important, but why is no mention made of cutting down meat and dairy consumption? After all a huge percentage of antibiotics used in the UK are actually given to farmed animals. Is this not worth at least a tiny mention?
www.theguardian.com/uk-news/2014/jul/07/reduce-antibiotics-farm-animals-resistant-bacteria

WeMissYouHissedTheLovecats · 25/08/2015 19:11

Agree with pp.

There is a huge amount of guilt tripping, lecturing from on high and moralising around people taking antibiotics for illness.

But what is being done about the MASSIVE amounts of antibiotics that are fed to farm animals to avoid them becoming ill/infected whilst not maintaining adequate standards of animal husbandry e.g. low cleanliness, overcrowded conditions? They are being used there everyday, in huge, industrial quantities, with little supervision or oversight.

But you are meant to feel really selfish and guilty if you think a chest infection needs proper treatment...

HackAttack · 25/08/2015 19:23

I disagree with this post. I don't know many people who demand antibiotics for no reason. I certainly don't, nor do I misuse them. Quite frankly I'm sick of this lecture for something I've never bloody done.

I took my lo to the doctor once when he'd been vomiting/high temperature and the G.P. sharply informed me he didn't need antibiotics (I hadn't asked for any). I asked now that he had ruled out what we did not need could he get on with his job of diagnosing and giving relevant advice.

Degustibusnonestdisputandem · 25/08/2015 19:40

New antibiotics could be developed, but there's not enough money in it, or so I'm lead to believe

TelephoneIgnoringMachine · 25/08/2015 20:12

www.theguardian.com/society/2015/jun/20/mrsa-in-pork-farming-leaders-join-calls-for-clampdown-on-illegal-antibiotics-use

We'd all probably be an awful lot healthier, for a variety of reasons, if we ate less meat as a nation. Aside from the immediate& obvious individual health benefits of reduced meat intake, the only way to produce that much meat, is by factory farming. Newborn animals are weaned early to allow the mother to get pregnant again quickly, the young are routinely given antibiotics to prevent illness which delayed weaning could would have partially prevented. Whole herds are commonly inoculated where only a couple of animals are ill, rather than allow illness and the associated reduction in growth rates.

OddBoots · 25/08/2015 20:18

I can understand your point. I know someone who tells people that they should say their sinuses hurt (when they don't) in order to trick the doctor into giving then antibiotics for a sore throat.

I don't think people realise what long term damage they could be doing to their gut bacteria and general microbiome when taking antibiotics either. Antibiotics are absolutely life saving for many people but they aren't harmless.

I get annoyed at how much antibacterial soap (usually containing triclosan) is pushed too.

StitchingMoss · 25/08/2015 20:27

I couldn't disagree more HackAttack - this message needs to be shouted from the rooftops again and again. I know many people who push for antibiotics for the slightest thing (earache is a common one) and get very stroppy if their GP dares to say no.

The misunderstandings and ignorance surrounding the overuse of antibiotics is frightening.

CoteDAzur · 25/08/2015 20:58

I don't know which doctors you people see, but getting antibiotics has always been needlessly difficult for us as a family. More than once, I had to insist on a blood test to prove bacterial infection so that DC could get antibiotics. (Paediatrician was saying it must be just one viral infection after another, seamlessly continuing for over two months.)

How on earth we got guilt-tripped about eating meat within 6 posts of the OP is another matter Hmm This fad of whining about meat consumption at every opportunity (or even when there isn't one, like here) is getting very tedious. I like eating meat and that won't change. FYI.

LeChien · 25/08/2015 21:07

I agree with you about meat eating, and I don't want to see farmers vilified, but they are paid lower amounts despite increasing costs, which means that the farms that survive tend to be bigger and more industrialised, which goes hand in hand with increased antibiotic use.
We must take some responsibility for this, and try to buy meat that has been responsibly reared, where possible.

HackAttack · 25/08/2015 21:07

Stitching then target those asking for them! I've never requested them in my entire life and get it shoved down my throat every time I see the doctor. My main issue is that GPs in my experience robotically repeat 'no pills' with no alternative advice.

On the occasion my lo went to the doctor it turned out pain relief to allow him to eat was needed (seriously bad throat, not an infection though).

I want a GP to actually pay attention and provide coherent advice. By all means if I storm in demanding penicillin then shout me down but if not then do the damn job properly.

StitchingMoss · 25/08/2015 21:09

But you don't necessarily NEED antibiotics even if it's a bacterial infection - myself and my DC never take antibiotics but we've manage to fight off a fair few infections just with our immune system.

This is what I mean about the misinformation and misunderstandings.

Obviously if the bacterial infection is serious that's different but we can fight off most minor bacterial infections on our own.

WeMissYouHissedTheLovecats · 25/08/2015 21:09

I don't think we should eat less meat. I do think there should be higher standards of animal husbandry.

StitchingMoss · 25/08/2015 21:10

This article is about informing all - how could it target those asking for them Confused?

HackAttack · 25/08/2015 21:18

I was referring to how I've found GPs are getting the message across, poorly in my experience. I've only had antibiotics a handful of times, part of a post op regimen and with pneumonia. Those are the only two as an adult, couldn't say as a child but I doubt it was much.

annandale · 25/08/2015 22:46

I really don't think I am that irresponsible about antibiotics. It would be great, though, if there were more facilities in this country to swab and test fast. My mother is always mystified that doctors seem to hand out their favoured antibiotic which only gets changed once the sensitivity results come through. If we had faster and cheaper sensitivity testing that could be done at the GP's surgery, A&E or in the ambulance, we'd have a lot less scattergun prescribing, surely?

itsbetterthanabox · 26/08/2015 00:01

You may like meat. That may not change through choice. It will change when antibiotic resistant bacterial infections kill millions. You'll be made to stop. Is it worth that?
The answer is quick testing of swabs/samples which research is going into. Widespread use of swabs/taking of samples before prescribing.
And no more factory farming or animals.

forago · 26/08/2015 00:45

I remember studying and hearing the warning this when I was at University 25 years ago! It's way too late now for existing antibiotics surely?

addictedtosugar · 26/08/2015 07:16

Totally agree, but we also need a system to support working parents. I know school isn't childcare, but if I can't send my preschooler til he has had antibiotic drops for conjunctivitis, or it has cleared, ditto for impetigo I need significantly more understanding from my employer as to why I need more time off work if antibiotics are not going to be issued.

BumgrapesofWrath · 26/08/2015 09:34

As someone who gets recurrent tonsillitis, I am tired of this message. Everytime I get it I am told it is viral by whichever practitioner I see (er, how do they know exactly the nature of my infection) as this is the party line. I am sent away and I then spend days trying to treat myself, which ends up with me a few days later in agony and terribly ill. I then get prescribed anti-biotics, but then as the infection is so bad it takes a long course, maybe two treatments to get it to go away.

I am angry at being made to feel guilty for wanting anti-biotics. I'm sick of the charade I have to go through every time. I am dreading my next bout as I know i'm going to have to be in agony before anyone will give me anything.

Yy to the people suggesting better testing, I totally agree.

itsbetterthanabox · 26/08/2015 09:49

Bumgrapes. They should offer it but you need to request a throat swab when you are having a bout.
Then you'll get the correct antibiotic which will work faster and better than a broad spectrum anti b. They will also know you are susceptible to this infection and will be more likely to help if it is a chronic problem.
Different health practitioners giving many different broad spectrum anti b's won't be helpful.

pretend · 26/08/2015 11:09

You need to speak to the OOH GP who prescribed antibiotics for my daughters tonsillitis, which he just finished telling me was viral.

I chucked the prescription in the bin.

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Regularhiding · 26/08/2015 12:42

Dental applications too - everyone please note - the treatment of a dental abscess is NOT take antibiotics "till the infection clears " then treat the tooth.

Unfortunately there are still some dental professionals peddling this myth. And a whole lot of patients who refuse to believe otherwise.

And as for the " doc refused antibiotics, it got worse and worse, doc eventually caved in and it cleared up" argument, most things clear up anyway.

Noregrets78 · 26/08/2015 13:00

And of course antibacterial products are all over this place - from cleaning products, soap, toothpaste, and impregnanted into high chairs...
www.smithsonianmag.com/science-nature/five-reasons-why-you-should-probably-stop-using-antibacterial-soap-180948078/?no-ist
Can't believe we don't see more on this subject - the focus is always on antibiotics (which is also an issue!)

Fantasyland · 26/08/2015 14:59

All this will do is make Drs be overly cautious in prescribing antibiotics like they are with painkillers and people who have a genuine need for anti biotics will be told they don't need them

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