Doctor or pharmacist, whose advice to follow?

[AtWitsEnd21]

Hi there

DS 3.5 woke up with v high temp 39.8 and complaining of sore throat. I took him to a walk in GP who said his tonsils are inflamed but no white spots. She prescribed ABs. DS 1.5 had been sent to A&E with concerning respiratory symptoms but no temp on Monday which turned out to be a similar ENT infection. While in A&E Dr said no ABs it was viral and would run its course which it has.

While collecting the ABs for DS 3.5 pharmacist said she would try hold off and not give them as younger DS recovered well albeit with completely different symptoms.

Im not sure whose advice to follow. I’ve constituted them and have them ready to give. DS is really struggling with temp and general feeling very unwell.

Any advice welcome

Take the antibiotics. They obviously have different things wrong with them which require different treatments.

Yes this is what I’m thinking too. The pharmacist threw me with her advice

I think as ds has been seen by the GP and prescribed the meds I would absolutely not listen to the pharmacists advice!
They clearly have very different symptoms and I’m not sure why the pharmacist would comment unless you asked their opinion because you are unsure? Did the pharmacist examine ds?

Doctor,they assessed and prescribed the meds there will be a rationale
Tonsilitis can be bacterial or viral. Determined by a swab. The medic assessed and prescribed, this is their recommendation
Dr did a swab, the pharmacist didn’t
Pharmacists Can decline to dispense a prescription that is incorrectly written or obvious dosage error eg child given an Adult dose

I would give the antibiotics.

There was no swab. It was a very brief 90 second consultation. Quick look in the throat and sent on our way. I suppose my reticence is the A&E doctor said that 95% of throat infections in children are viral.

You have seen a doctor who has prescribed antibiotics

Your child is unwell and has a high fever

Give the antibiotics, it could turn to Strep and he could become VERY unwell

On Balance I’d give the antibiotics

Different doctors and different symptoms so I would give the antibiotics

Thanks for the advice, I gave them to him. I agree about the risk of Strep (although I asked and doctor said no evidence of it) out weighing all other outcomes.

I'm sure you know this @AtWitsEnd21 but once you start a course of antibiotics it's really essential you continue to give the full course prescribed - even if your child seems better - as otherwise the infection can return worse than before and potentially become resistant to the antibiotics.

I'd start the antibiotics personally

Absolutely. DS has been very unlucky with illnesses since starting preschool so I am well versed in all things antibiotics. Thank you though

I would definitely give the antibiotics as advised by the dr.

However it's likely they do both have the same thing, the same virus can produce very different symptoms in different people. It's also likely that's it's viral and DS doesn't need the antibiotics.

The dr will have assessed the likelihood of it being viral but has obviously still decided to prescribe meds so I'd take them.

Hope they are both better soon

I think the pharmacist may have been correct but it won't do long term harm if your son has antibiotics.

Yes I feel it is probably the same illness but with incredibly differing presentations. DS 1.5 was sent to A&E with oxygen sats at 87 and a respiratory rate of 52(!!) albeit running around and content, when he was assessed he was found to have the exact same as DS today- enlarged and inflamed tonsils. DS 3.5 in contrast had a temp of almost 40 and very sickly and lethargic.

GPs tend to use FeverPain score as guidance for who gets antibiotics. That and clinical judgement.

www.mdcalc.com/calc/3316/feverpain-score-strep-pharyngitis

That’s a great metric, thanks for sharing

Really useful, thanks!

Are pharmacists able to question or disagree with a doc's diagnosis or treatment choice? 😳

I really value the advice of pharmacists. I’ve had so many positive experiences with them especially in relation to childhood illnesses. It wasn’t done in any kind derogatory way, I asked their advice as what the GP said seemed to significantly contradict the A&E doctor.

Just to say, antibiotics aren't a 'no harm' drug, they do have side effects including gastrointestinal effects (they can wipe out the good bacteria in the gut) and antimicrobial resistance is on the rise and a real cause for concern

I'm not saying you shouldn't have given them-not at all- but they aren't sweeties!

To answer your actual question - pharmacists are more drug experts rather than diagnosing experts.

Your GP for the diagnosis and treatment.
Pharmacist for drug interactions or advise something is a wrong dosage. They can't even change a prescription from 1 x 50mg to a dose of 2 x 25mg despite it being the same doseage as the GP is the one who actually makes the final decisions.

Follow the GP's instructions. If you disagree then get a second GP's advice rather than ignore.

Absolutely. DS had one antibiotic in his first three years and then as soon as he started preschool was hit with an avalanche of illnesses that have at times requires antibiotics. I’m hoping we will emerge from this illness season soon

Pharmacists are skilled and trained in drug interactions,prescribing and dispensing
GP skilled in assessment,diagnosis treatment,prescribing
Different jobs, different training