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?

Agree with a lot of posters on here. I work in a sexual health clinic and a lot of people demand antibiotics left right and centre, even when there’s no evidence they’re needed. It seems to be expected, as if it’s some kind of prize for coming to clinic. To be clear, I’m not talking about people who test positive for bacterial STIs -of course they need antibiotics - more those who come in with symptoms which aren’t related to infection but still want to be handed out antibiotics like Smarties.

Teddygirlonce

So continue to make it impossible to get all meds in them instead? 10 mth old takes calpol. Why can't amoxicillin be made similar?

Oh, and I don’t prescribe them when there is no clinical evidence that they’re needed, but I know some colleagues who do cave in to the pressure on occasion

@Wellandtrulyoutnumbered what do you mean by more child friendly?
Dd always had the ones you can give with a spoon or syringe just like calpol. She particularly enjoyed the banana flavoured one.

Just to clarify from the animal prospective......Antibiotics in animals also need to be prescribed they aren't given out as easily as people think.
All drugs given to animals designated for human consumption have known withdrawal periods(the time it takes for the antibiotic to have left all the tissues in an animal and this also has an extended buffer zone for extra safety)Organically raised animals can have antibiotics but they have longer withdrawal times(nonsensical in my opinion as the initial one is already scientifically proven but theres a lot about organic farming thats a little strange imo) Certain drugs cannot ever be used in animals going into the food chain as they live on in tissues for to long....so these are banned in food producing animals. These regulations are strictly adhered to and there are massive consequences for not doing so. Abbatoirs have systems in place to check for issues.vets work on the line and check carcasses for signs of needle marks etc while doing some of the health checks(multiple different diseases checked for) and random tissue samples are taken and checked as well for chemical contmination(dioxins etc were found this way).There are massive consequences for the owner of the animal if any residues are found- department inspection and fines etc. Each animal is traced from farm to fork thankfully so its known who is accountable. In the dairy industry entire tanks of milk on farm are condemned if an animal who is still in the danger zone is milked into the holding tank...and the actual dairy's test each sample from the trucks as they arrive. If mess up and milk an animal you shouldn't into the tank and don't catch it(many farmers have snap tests to check on farm at this stage)...and your milk contaminates an entire truck from multiple farms... then the farm in qn faces paying for the loss for all affected famrs and a massive fine as well. Theres lots of incentives to keep our milk and meat safe from antibiotic contamination thankfully and its taken seriously. Vets have this stuff bet into them(heavily emphasised :P)during collage in the public health parts of the course and if you look at most of the vet oaths across the world human public health is included as well as animal health. Antibiotic resistance is one of the massive future concerns to all species health in the next 50 years!

From a purely personal perspective, I've always had real difficulty getting antibiotics prescribed from my GP (not just one GP, a range at a large practice).

I have suffered from terrible UTIs on and off my entire adult life, and the ONLY thing that works is antibiotics. But pretty much every time I have another infection I have to wait for a sample to be sent off to confirm its bacterial before I get the medication. I'veonly in the last year found sympathetic female GP who gives me the prescription at the first sign of infection, and its made such a difference to my life.

Ditto for when I had an awful run of recurrent tonsillitis years over a few years. I was repeatedly refused antibiotics until it had become very, very bad. I remember crying and begging the out of hours GP to just look at my notes and see that ONLY antibiotics gets rid of it, EVER, therefore it CANNOT be viral.

Its a shame some people ask for these drugs unnecessarily as it makes it harder to get them for the rest of us.

Hang on, GPs often say viral but sometimes the infection is actually bacterial and needs antibiotics to get it cleared up. Unless the GP is going to swab every patient, then they can’t always tell what’s viral and what’s antibacterial.
That’s why they tell you to come back if your infection doesn’t clear up... it could be bacterial.
If you can face it, there are stories of children having died because their parents were told they had a virus.. when actually it was bacterial and they needed antibiotics.
Look it up.
I think the public needs to not demand antibiotics.. but for god’s sake let’s not become a baton that misses serious infection by labelling everything as viral

*nation not baton. Sorry for typo

We've recently been prescribed the cherry favoured one. It's grim. Can't be hidden. Apparently only favour it comes in. Can't hide it. Can't get it in kids. Tastes like aftershock (hideous flashback to clubbing days)

Possibly a decision by prescriber on cost.

Have had banana and peach. As well as plain bitty white stuff.

All of the children have found it so hard to take. It becomes a huge battle despite trying to keep it calm. Tried incentives too.

With sixteen years of parenting and five kids we aren't daft. They'll take the sweet sticky calpol but amoxicillin fails us everytime.

Lots of friends have same issue especially those with sensory issues like my son.
It's exhausting.

@Wellandtrulyoutnumbered og right i get it now. And sorry,didn’t mean to imply you’re daft or anything.

Haven't RTFT.

My understanding is that part of the problem is people don't finish the whole course but stop taking them when the feel better. This doesn't wipe out the problem 100%, allowing the illness to mutate and be passed on. This mutation can include an increasing resistance to the antibiotic.

tamberlane you misunderstand about the use of antibiotics in intensive farming. The persistence of the antibiotic in the meat is not the issue with respect to antibiotic resistance.

There is a common misunderstanding that antibiotics cause resistance in the host, they do not, they cause resistance in the gut bacteria of the animal. Those resistant gut bacteria have still been pooed out into the environment, washed into river water, used to irrigate crops and fed back to humans or other animals even if the antibiotic concentration of the final meat product is zero.

As PPs have said, the "finish the course" thing now looks to be unlikely - and may actually be contributing to resistance.

I feel sorry for GPs as they are in a tough situation. But if I went in and asked for morphine for my cold, I wouldn't get it. The GP would say no even if I got upset and insisted and said I had it last time. So they are able to say no, they just don't when it comes to abs.

Dd1 had ab at birth for infection in labour. Then nothing till 3yo when started nursery....
She had mmr (live vax) and caught hand foot and mouth at same time. Then had frequent fevers 40+ deg so a uti. But then fevers again no cause found until both ear drums burst. So AB for that. After that several more fevers lots of extreme pain from bursting drums. And maybe 6 burst drums that year.
Next year following awful d&v bugs another burst drum (where ooh convinced me we didnt need to be seen and dd2 was actively vomitting, waited until morning gp appt so it was too late) then another d&v and then ear pain and got to gp in time for AB so managed to prevent another burst drum.
What dd needs is referral to ent to investigate cause (allergy/reflux etc) or grommets and tonsils/adenoids removed. After all the fevers she suddenly had a heart murmur and now has permanently swollen neck glands.
So as other posters she has had a lot of AB but it is either that or permanent hearing loss.
Also if someone has a bacterial infection that isnt treated it can also be spread to others. Several kids (5 or more) all had ear infections at the same time.
Ive had gp say you dont need the AB but now i know the symptoms (if she complains of pain it WILL burst) a watch and wait is not appropriate. Also one of the times about 4 different people checked her ears and couldnt see the infection (prone to ear wax).
Also agree with PP about the fevers, its awful, she cant seem to control her temp and it will go really high and wont come down even with both ibuprofen and paracetamol.

More operations to remove tonsils/adenoids are necessary.
And i dont think long term ill health and glue ear hearing problems are helping kids behaviour (adhd links)

I think eventually swabs will have to be taken where possible. Maybe instead of a gp appt you just swab/sputum sample.

Calpol is delicious! I used to love it as a child. Also the banana flavour antibiotic is nice (Septrin - TMPS)

It's impossible to tell what's virus and what's bacterial without testing. Therefore a proportion of patients get ABs that don't need them...or a proportion don't get them even though they need them. If we are going to cut down on AB use in humans we have to accept that more children are going to die of cute bacterial infections.

Resistance occurs mainly in immunocompromised people/animals or people/animals who are taking loads of ABs... a healthy person taking a short, one off course is unlikely to end up with a resistant infection. That's why most of the problems occur in hospitals where there are lots of very sick people.

It's scary - so many more children would be dying without antibiotics, and we are going to end up back there soon. If it were up to me I'd increase restrictions a lot more, there are loads of different antibiotics and only one or 2 should be allowed in general use, the rest should only be used in desperate situations

* Do GP's really give in to people demanding antibiotics?! I might go into my surgery and demand some opiates to get me through Christmas.*

How I wish this was a joke, community prescribing has a lot to answer for.

It's a real 'soap box' issue for me. I've taken them twice in 20 years and DD has only had them twice. I've friends and my elderly mother who seem to take them for every ailment. My mother was a nurse and should know better. Drs just seem to take the path of least resistance- same thing with signing the forms for renewal of their elderly patients driving licenses.

So are we to appease a culture of people who kick off, cry or demand medicine so they dont make a scene.

Have to agree. The last thing GPs should do is give a AB prescription just because someone is kicking off etc. They need to grow a back bone and refuse. If the patient kicks off, then it's a security/police matter. The more we, as a society, pander to the loudest/most aggressive, the worse it becomes.

I think I “made” my GP give me antibiotics once.
Went in twice in the course of three weeks as what started as a common cold got worse and worse. Kept being sent away with “take paracetamol,honey and lemon bla bla bla”.
Until i got really ill. It wasn’t just the fever,and the shivers. I couldn’t breathe properly, wheezy and getting faint simply from going from one room to another. My chest felt like it was tearing aapart everytime i coughed and i spat out delightful green and yellow, foul smelling mucous.
So I said fuck this, made another appt,went to his office spat the stuff on a tissue,showed him and asked him to fix it. He listened to my chest, gave me AB and I was better in two days.

GPs often say viral but sometimes the infection is actually bacterial and needs antibiotics to get it cleared up.

even if the infection is bacterial, your body will in most cases deal with it and you don't need antibiotics.
just rest, just like for a viral infection.

our bodies are amazing and are usually very good at healing.
people with recurrent infections might need to have a look at personal hygiene to prevent re-infection. (if you get recurrent uti's you need to boilwash your underwear and your sexual partner needs to wash properly before)

As a GP you are juggling probabilities. I find some patients don't accept that. So you aren't saying that this ear infection definitely doesn't need antibiotics ever. You are saying that they aren't indicated today as it is most likely viral and self limiting. However there will be a minority of patients in your position who will get worse, or get a secondary bacterial infection, and need antibiotics then. There will also be a very small number of patients who will have a very serious complication eg sepsis, perhaps unpredictably.

Most people can appreciate this and you can advise them to seek a review if not better by X date or if they get Y, Z symptom, and they understand that it probably wasn't the GPs fault if they deteriorate later and need antibiotics then.

But if someone is crying, shouting, saying they will complain, saying they will blame you if they suffer a complication, then I can understand why some doctors might end up prescribing, because there is a chance that person will get worse, and a complaint is horrible and v upsetting and time consuming (even if groundless).

I think what really helps is if GPs have good back up from the practice if they legitimately say no (eg that your colleague won't prescribe antibiotics to pacify the patient if they complain about you), and if spurious complaints can be dealt with appropriately without dragging on for ages.

Also public education about generally not going to the GP the first day of a sore ear, mild D&V etc, often people dash straight in and it is limited what you can do for them at that time. I find patients seem to feel short changed if they don't get either a prescription, blood test, referral to leave with, but on the first day of a (probably) minor illness there often isn't anything that a GP can do!

@HopelesslydevotedtoGu i was sniffling a bit but that’s because getting my ass all the way to the GP took a lot out of me.
I found it funny when he did give me ABS for infected stitches though,just on my word.

Him: Do you want me to look?
Me: Errr...dunno, don’t you have to?
Him: No.
Me: oh ok then.
I wasn’t gonna explicitly ask him to have a look at my vulva.

Thinking about this yesterday when I went to OOH for breakthrough analgesia. Nurse said I had a fever and said probably another UTI. Doctor came through, said probably a UTI and I explained have had 16 prescriptions in last 12 months for a UTI, none of which have worked beyond 2 or 3 days - consultant thinks my bladder is ulcerated or otherwise inflamed for some reason. Managed to persuade doctor I don't want any more stuff (have had ciprofloxacin, amoxicillin, nitrofurantoin, coamoxiclav, cefradine, flucloxacillin ..) , I know what a kidney infection feels like and what's concerning. Thankfully he agreed and said could go home on analgesia and to come back for abs if fever doesn't go etc. Much better! If I didn't know what to look for though in terms of changing symptoms , and didn't have a decent GP surgery , probably would have asked for abs .

UnicornSlippers They're not making you wait for the sake of it. The test is to determine which kind of antibiotics will work on your UTI. If your GP is prescribing a particular antibiotic without knowing which one you need, she's part of the problem.