To wonder why the public are blamed for antibiotic overuse?

[moutonfou]

I heard some kind of public announcement on the radio today berating us for over-using antibiotics and urging us to stop.

AIBU to think that as antibiotics are prescription-only, it's medical professionals (and farmers) who are responsible for any overuse? Yes, I'm sure some patients with no idea how they work want them for anything and everything, but all a GP has to say is 'I'm afraid antibiotics only kill bacteria and you have a virus.'

Personally I detest antibiotics as they give me thrush and diarrhoea every time, but if the GP deems that I need them, I take them. Does the government think I should be protesting or refusing or something?

It’s because people go to the doctors over a cold and the doctors not able to do a bacterial screening just give antibiotics as a failsafe. I see it on a regular basis at work when simple cold and flu remedies, vitamin C are all you need. That’s not to say all the people who get them don’t need it, I agree people with COPD/lung, heart, cancer, immune etc conditions need antibiotics.

I am a frequent sufferer of uti's. It terrifies me the prospect of antibiotics not working. The rest of my family never take them and I wish I didn't have to.

I can’t imagine that many GPs would have the ability to refuse to prescribe antibiotics for a very frail, old person because it is their time to go.

That's irrelevant for this argument though isn't it? When you're old or near end of life, it doesn't matter about future AB resistance does it? The argument is all about giving ABs unnecessary to younger people where it may make them resistant to AB's in the future when they really need them. Giving ABs to prolong life in end of life scenarios is a matter between doctor, patient and relative - it doesn't matter whether they'll make the patient resistant to future infections as they won't live long enough anyway.

I suspect people wouldn't be pushing for them so much if they had to pay for them for their DC! Perhaps it should be a case - with antibiotics - that if the condition (i.e. viral) doesn't necessitate them parents have to pay for the 'script' if they insist - I suspect that would dramatically reduce demand almost immediately!!

For those who suffer with recurrent conditions which require antibiotics I have every sympathy. DM has a condition which sees her in hospital every few years and really ill with bacterial infection. She is allergic to penicillin based ABs and has just about run the full gamut of alternatives that work for her infections. On her last hospital admission (fourteen weeks) she had to be prescribed one that required the say so of the chief NHS Trust pharmacist.

karrie I think there may have been a misunderstanding here. Most concern about drug resistance in bacteria isn't specifically over their resistance within the person being treated (though this is one concern). Rather, it's over bacteria in the population at large being exposed to antibiotics more frequently than necessary and there therefore being greater evolutionary pressure thus meaning that drug resistance confers a greater advantage and so those strains are more likely to proliferate amongst the population as a whole and thus create risks for everyone, not just the people being treated.

Sorry if I misunderstood your post or haven't explained myself, happy to try again if it's not well written.

Karrie
It's that the bacteria mutate and change becoming resistant to the antibiotics. It isn't about a person becoming immune. So yes it does matter with old people.

I don't think the public should be blamed, but it is absolutely right to try and increase public awareness of the problem with antibiotic resistance/that they don't work against viral illness and that there are a number of self-limiting bacterial infections which antibiotics will only reduce duration of illness by around 24 hours (so for most people, antibiotics are not necessary).

I'm a HCP. Many patients do demand antibiotics, even when it's been explained that they son't need them. I agree that the Dr or whoever simply shouldn't prescribe antibiotics where they aren't needed, but I do have sympathy with the GP's- they have 10 minutes to take a history, examine the patient if necessary, discuss treatment plan, prescribe and write up notes. Trying to do all that and then spend time arguing with a patient who is demanding antibiotics (especially those who keep returning)- I can imagine how they could become worn down and give in. Especially at a time where GP's are stretched.

Not that any of the above is an excuse for poor prescribing practice- but it does go some way to explain how it happens. Antibiotic prescribing is something which is being targeted as part of guidance (local and national), CPD and prescribing audits and there is pressure being put on Dr's and other prescribers to tighten up their practice. Rightly so. BUT it would also help if patients played their part and were more prepared to accept it if their GP (or any other HCP) doesn't prescribe antibiotics.

In the same way there has been a push to increase awareness of sepsis, there should be a push around antibiotic use.

We have very robust constitutions in our house possibly because we were brought up in an era when you didn't just go to the GP with every sniffle - you had to be really ill! And TBQH that's the rule we still apply with our DC. I'm sure they're less likely to be floored by a viral/bacterial infection because their immune systems have become stronger for fighting off previous illness without a visit to the doctor and a 'script' for medication.

Sadly, that's not how it works. You're just lucky.

I don't think the public should be blamed

When people don't complete the course or don't use the antibiotics properly, or even when they give them to someone else without medical advice, then the public should be blamed, yes.

How do these people find the time to see the GP that often?

Also agree with Lweji- the other things is it's important to encourage everyone to the antibiotics that they are prescribed correctly- e.g. making sure they complete the course and take them as prescribed. It's not unheard of for patients to start taking antibiotics they've had left over from an incomplete course (so taking another incomplete course- and sometimes then going to their Dr and requesting another course as they're still not feeling better). I have also come across people who have given antibiotics prescribed for them to someone else (most often an incomplete course). All of these need to be discouraged by increasing public awareness.

Part of the problem is that people also fib to doctors to get them.

I have a friend whose DD is very prone to tonsilitis and gets antibiotics because she has convulsions with a temperature and has other health issues. They don't even insist on seeing her because the mother can smell the infection.

However they don't seem to realise that at least twice this year she's used the antibiotics for her son when she was sure he didn't have a virus.

(It has been passed onto them, but I think they just don't have time to see the DD every time).

I would love to need less antibiotics unfortunately I seem to develop tonsilitis every 6-8 weeks (the white spots kind) I leave it several days before seeking medical attention and every time I go with a temperature of 38+ am told white spots ALWAYS equals antibiotics.

I should have had them removed as a child as I had ear infections and tonsilitis permanently but as a child or the 80s it wasn't the done thing. My own dc had their adenoids and tonsils removed and grommets inserted at 4 and we've never looked back!

Apparently they don't like removing tonsils in adults so I'm stuck with this permanent cycle

Outlaw, I had my tonsils removed at 31. Best thing I ever did :)

Doctors are under so much unnecessary scrutiny but nobody seems to monitor their prescribing of antibiotics. Maybe if there were sanctions for it, the would be firmer with patients. I don't agree that they're excused to giving into pressure because the patients might kick off.

My recent experience was that antibiotic were prescribed as a last resort (as they should be) after trying other medicines.

Also agree with Lweji- the other things is it's important to encourage everyone to the antibiotics that they are prescribed correctly

Thanks. :)

However, it's not my opinion. It's research based information. With properly used antibiotics, all bacteria die. If exposed to non lethal doses, then some bacteria survive. The survivors are resistant to high doses of antibiotics and will eventually generate versions that have increased resistance.

One problem is that once one species of bacteria develops certain types of antibiotic resistance, then it can pass it along to other species, mainly via plasmids. For example, if you acquire one resistant gut bacteria strain, very soon you could have many other resistant strains.

The problem is that GPs only give prescriptions for shorter courses of antibiotics - this sometimes results in mutation and resistance rather then cure.

If the medical profession are serious about restricting antibiotics to people who actually need them, they could administer antibiotics by injection only, which should filter out those who aren’t desperate

The problem is that GPs only give prescriptions for shorter courses of antibiotics - this sometimes results in mutation and resistance rather then cure

Not sure what the evidence is for that? Antibiotic choices and duration of treatment are based on local microbiology guidelines. For straightforward UTI, for instance, evidence is a 3 day course is sufficient for most patients. You treat with a 1st or 2nd line antibiotic (in our area trimethoprim or nitrofurantoin or cefalexin in certain situations), if recurrent/not settling with treatment then treat with an alternative and urine should be sent for culture. For a lower respiratory infection in an otherwise well person then a 5 (or sometimes 7) day course of a suitable antibiotic are usually sufficient.

When treating blindly (i.e. without benefit of knowing what the causative organism is, nor what antibiotics it is resistant/sensitive to) it is not surprising that sometimes the 1st line does not work. But they are based on evidence, nonetheless- i.e. for any given type of infection there will be bacteria which most commonly cause it and this guides antibiotic choice in the guidance. Every so often a patient will have a strain resistant to that antibiotic or an atypical cause of infection.

There are certain infections (often proven after urine/sputum or swabs sent for culture and sensitivities- or blood cultures if an in-patient) where a longer course may be appropriate.

There will never be appropriate restrictions on antibiotic prescribing because, if there was, people would die. People will die anyway due to resistance, but nobody will want to be that person who says they’ll need to be rationed.

The resistance problem will worsen and the best we can hope for is that effective alternatives are discovered. Perhaps there’ll be a window where many deaths will occur and operations won’t be able to go ahead and maybe there won’t be if new antibiotics are developed soon.

I think making antibiotics more child friendly would mean courses are completed and help with resistance.

We've just directed amoxicillin as couldn't do it anymore. Horrendous.

*ditched

I think making antibiotics more child friendly would mean courses are completed and help with resistance

Meds aren't supposed to be child-friendly though are they? That's not the point. If you've ever tasted Calpol you'll know that...

From memory I think my D'S who is 21 has had 3 lots of AB's in his life...he had an ear infection when he was about 3, lovely gp gave me the prescription to collect "unmade up" to give only if eardrum burst ...and as he said they always burst at 3am!.. it didn't burst so never used.
DD (18) has had 8-10 courses in her life...2 burst ear drums, impertigo x2, Quincy and UTI etc
Have never wanted to give them but sometimes they are needed and it scares me that one day soon we will live in a world where they don't work

So are we to appease a culture of people who kick off, cry or demand medicine so they dont make a scene. 1 warning then police called. Ban them from surgery for x weeks. Country needs to man up. We are sentencing our children/grandchildren to death for currently treatable ailments through being spineless.