GP prescribing drugs without doing sample first

[lozrobin]

I am pretty annoyed on what has happened to our newborn son - should I be as worried as I am and should I complain about our GP ?

When born our son had a bit of a gammy eye - midwife said quite normal and just put some breast milk in it and should clear up. Week later health visitor came and immediately booked GP appointment for 10 minutes time meaning I could not get home from work and really worried
my partner who had to dash to GP's (luckily just round corner), GP prescribed chloramphenicol drops and said to put in both eyes 4 times a day, my partner thought he said for 4 days but baby was screaming at time and GP did not put how long on the prescription. He also said to put it in both eys but when my partner said only one is bad he then said well only put it in that eye.

When I saw the drops and read leaflet I was really concerned about the side effects (grey baby syndrome - which appears lethal amongst others), we held off for another two days using breast milk but as it hadn't cleared used the drops for 3 days at which point started to look better. As it did not say how long for on prescription my partner asked a different GP she was seeing about something else - he said should stop and asked why a sample wasn't taken before drops were prescribed - nobody had mentioned this as a possibility. Knowing I would be annoyed my partner didn't mention this. Should say the baby was only two weeks when drops prescribed.

In last few days baby has been turning blue in the face and been to hospital to be checked and all apears okay and apparently can happen and be wind. The midwife on hearing this showed up and then also said why on earth was he precribed those drops as a sample should have been taken first (why she didn't do it originally is a mystery).

On a bit more research those drugs are for babies older than 2 years only and only prescribed younger by a GP when severe conjunctivitis and has been confirmed as needing strong antibiotics. My partner told me about this as she was now a bit worried it could be linked to the blueness. I am very annoyed as since spoken to paedatrician at hospital who has confirmed this - basically appears he should not have been prescribed what is a very strong antibiotic without a sample of the gunge fro his eye being analysed first.

To top all our worries a symptom of grey baby syndrome which is a side affect of the drug is turning blue. This had us worried to death but hospital thinks all is fine as just round his mouth and eyes and feeding okay and otherrwise appears perfectly healthy.

It has however got us very worried and I am fuming at the GP - been closed over bank holiday so not had chance to speak to him - has anyone else had similar experience - am I worrying over nothing and would you take it further ?

Many thanks,

Lawrence

I think I would take it further to prevent the same happening to another baby. Just ring your surgery and ask about their complaints procedure. They should give it to you without asking too many questions. Then you can take it from there.

It sounds dreadful, I'm sorry you have had to go through this and I hope you are all ok.

Oh so sorry you've been through that. I would ask to speak to the practice manager - so you can ut forward your concerns/complaints and get some answers as to why the decisions were made.

If you still disagree then complain.

Hope your LO is better soon, keep an eye on the blueness and if concerned return to A & E.

Please try not to worry though just enjoy him - they grow up scarily fast.

Did miss a little out on the story which was the health visitors number one concern was that his cord looked strange and thats the reason for the rushed appointment - the eye was looked at in the same appointment - the cord was fine and get the impression our health visitor is quite new and prone to panicking as the midwife was not worried about either of the two things although feel she did fail us a little as on the last visit said if we had spoken to her she would have come and taken a sample so wander why she didn't do this opiginally but ultimately buck lies with the GP.

Seems strange to me too that he would take a sample as conjunctivitis is fairly common in babies and is a pretty simple thing to diagnose. Remember too that midwives are not Dr's and often like to take things into their own hands when really they should be seen by a GP. He may have said to put them in both eyes because conjunctivitis is very contagious and he may have done that to prevent the other eye from becoming infected.
My daughter had a lot of problems with allergies,breathing problems and eczema and she was often prescribed drugs where the label would say 'not suiable under... yrs' This is often a precaution on the part of the drug company.
I would wait a few days and if you do get any serious side effects or more problems go back and see your paed. Often Dr's disagree on prescribed drugs and doses but I think your Dr should know what he is doing.

Unless it's really severe I thought the protocol was to give it a few days to clear on it's own and then give antibiotic drops.

I can understand your frustration but not sure the gp did anything wrong here tbh.

You mention a seemingly unrelated problem (but obviously scary) as your reason to be annoyed?

I think you are way over reacting. What your GP did is standard, safe practice, and I am sure is no way linked to your baby going "blue", which seems to have been proven to be nothing.
You need to calm down TBH.

We had these given when DS under 2 and no swab taken. I don't think a swab is needed.

Unless there is a concern about chlamydia or gonorrhoea then not really neccessary to swab. I probably wouldnt have bothered with the chloramphenicol, but the side effects you mention are incredibly rare.

The GP has never taken a sample from either of my children for conjunctivitis, I would be surprised if he did. As for the eyedrops, 11 month old DS has been prescribed them twice and he hasn't come to any harm.

Lots of babies get a dusky, blue tint around the mouth when they have wind - it's a bit worrying but a good burp usually clears it up.

To be honest I think you might be overreacting a little and maybe you should trust your GP, back away from Google and enjoy your baby.

Most medicines are not tested on children (who would volunteer their children to do it?) so are not licensed for use in children. This means that many medicines, which children use regularly and would often die without, are labelled with directions for over ... years. Do not panic about this, it is very common. Swabs are not taken as a matter of course for conjunctivitis as far as I know.

I am more shocked at a midwife recommending breast milk as, although it may well work, it is totally unproven and has no evidence base.

It is worth asking the practice manager to check if this is all ok but, personally, I wouldn't approach it as a "complaint" as it all sounds reasonable.

When DD was young (about 8 weeks) she developed yellow crusty skin on her eye brows. I thought it looked like cradle cap, but at the time thought cradle cap was confined to the scalp so I took her to the doctor on Thursday.

Doctor diagnosed a skin infection and prescribed Fucidin. She told me only to use a tiny amount and confine it to the area that was infected. The skin behind her ears was also looking a bit sore and the doctor told me to use the cream there too. I thought it was a bit strange to use the cream on something that looked totally different to the eye brows.

By Saturday the 'skin infection' had spread to her scalp so I went to our local pharmacist as I didn't want to put the cream on a large area after what the doc had said. He told me to continue using the cream (probably didn't want to over rule doc) but to see the GP again.

On Monday I saw a different GP. He said he would NEVER prescribe Fucidin for a baby. He diagnosed cradle cap and, prescribed hydrocortisone, but said try olive oil first and only use the hydrocortisone as a last resort.

I didn't say anything at the time as I think I was still too much in daze from the birth, but I wish I had. Turns out she was a newly qualified doctor. She is no longer working at the surgery - I don't know the reason why but I have jumped to my own conclusions.

Basically, what I'm trying to say is that I would say something. Sometimes it's fine for doctors to prescribe outside the manufacturer's guidelines, but it's definitely worth getting it checked.

I hope all is ok with your son.

I work with newborns and chloramphenicol is used very commonly. I have never seen it cause dusky episodes. I would imagine that you were given a bottle that was labelled for over the counter use by the pharmacist - the drops are exactly the same inside but it's not licensed for OTC use in babies because the manufacturer and pharmacist would rather young children are seen by a GP than self (ie. parent) medicated. My dd was treated for conjunctivitis as a baby without a swab being sent, it's easier and faster to see if the baby responds to treatment than wait a few days for swab cultures to grow and then treat.

I agree Pink but as I said before often Dr's have different opinions on what to prescribe and when. I was prescribed Eumovate for my 4 month old daughters eczema at the time by a dermotologist. When I told my dad (a former medical Dr) he was horrified. A few months went by and my daughters skin looked so much better - she had suffered so much with it that my dad seemed to change his mind. Remember they have also qualfied at different times - medical opinion changes and new medications come out,new trials are being done and new research is there.

If the Dr had made a serious mistake I would say yes - it should be investigated but it doesnt seem something to me to complain about tbh.

Conjunctivitis is extremely common and chloramphenicol is not allowed to be sold over the counter to under twos but it is allowed to be prescribed. Doing swabs is all very well in hospitals when you have quick access to labs but in a GP surgery it is not really carried out for such a common ailment, would you really have wanted to wait around for a wk for the results before treating?

I've been working in primary care for 11 years and have never taken an eye swab for suspected conjunctivitis, even in a baby.

The swab would take days to come back, even longer lately with all these bank holidays, and by then the infection could be even worse.

Breastmilk can be useful for sticky eyes (no clinical evidence that I'm aware of but it does have antibacterial properties apparently) but for a properly red, gunky infected eye then antibiotics, usually chloramphenicol, are needed.

Yes fucidin is fine for babies, even the manufacturer doesn't give a lower age limit and they definitely would if there was a risk of any problems! It's unusual for it to be prescribed first line ahead of olive oil but olive oil can take a while to work with lots of skin scraping whereas fucidin would be likely to be more effective for a bacterial infection.

The information on chloramphenicol drops being for those over 2 years old refers to the OTC (ie licence for sale) guidance for the drops. In all areas of Scotland except 2 there is a PGD in place allowing them to prescribe it from 1 years old and doctors can prescribe it from any age.

I wouldn't be unusal to take a swab from a baby getting conjucntivitis so young but it's not unusal to treat first. In any case it would have been likely the GP would have prescribed the chloramphenicol empirically after taking the swab to avoid any undue delay in getting the infection treated. Standard length of treatment would usually be about 5 days.

Any side effects from chloramphenicol are more common when the drug is given orally and that would be treating something else entirely.

One of the things to remember is that GPs and hospital doctors see very different groups of patients. A GP will see hundreds of normal everyday conjunctivitis and prescribe appropriately. A hospital doctor will see those cases which are difficult or complicated and have failed to respond to normal treatment, in which case a swab would be more essential.

I think your GP behaved entirely appropriately - he prescribed an effective treatment for a common condition. A lot of medications that are used on babies have very rare side effects that are enough to fill us with dread but that are very effective and benefit outweighs risk.

Complaining is probably a step too far, but maybe just get clarification from the doctor who prescribed it to put your mind at rest.

I'm a bit neurotic, so probably not the best person to take advice from.

Thanks 1ggle. I guess they all have their preferences for different drugs.

How old is your baby, Lawrence?

Lawrence, what worries me is your statement that 'knowing I would be annoyed my partner didn't mention this'. Why? Do you often lose your rag? Your partner shouldn't be pussy footing around for fear you'll get angry. If you have problems keeping your temper then you need to deal with them now, because someone with a short fuse is not a good person to have around a baby.

I hope I'm over-interpreting this - you are a new parent and anxious and worried about your baby - but no-one should be forced to hide things from their partner to avoid the partner throwing a temper tantrum.

DS when he was newborn had a gunky eye, manky cord and a funny lump on his head (got a bit squashed on the way out). Gosh he was a looker!

He never had a swab taken for his eye but he did for his cord stump, both of which cleared up on their own after a while (the breast milk didn't seem to do much but cooled boiled water on cotton wool to wipe away the gunk worked quite well). Various people got het up about his lumpy head but with hindsight I can see they were all inexperienced and extra cautious. Particularly after DH took him to paedatric A&E after a panicked HV over-reacted and was nearly laughed out the hospital but my point is they were all acting in DS's best interest within the confines of their experience.

I think you are over-reacting about this and need to relax a bit. Your partner shoudn't be afraid to confide in you - you are a team. Try not to spoil this precious time by being too anxious. As a mother I was really surprised just how quickly my instinct kicked in but I had to chill out a bit for it to be reliable.

Just checking in the BNF for Children - no mention of 'grey baby syndrome' with chloramphenicol eye-drops, as I thought. So, not sure how it came to be on your leaflet.

I'm concerned that you are creating uneccessary anxiety about this proven safe treatment.

And there are other inconsistencies in your postings about your baby.Shame on you.