Please explain the anti antibiotic campaign...

[gottastopeatingchocolate]

I am probably being a bit dense, but the campaign telling us not to take antibiotics without the Doctor's advice is driving me up the wall!

I understand the issue, but why are they telling us -14 times a day- when you can't get antibiotics without a doctor prescribing them?

Am I missing something?

There's loads of issues around this.

People demanding antibiotics when they won't be any use (or buying them online), people getting given a course of antibiotics when they do need them but not finishing the course because they feel better (any remaining bacteria can then develop resistance to that antibiotic)
The agricultural industry routinely dosing animals with them so that they can practice intensive agriculture.

All of these things contribute and it's so sad. Antibiotics were and are a wonderful thing that we have taken for granted and squandered. As bacterial resistance grows people will die from infections post surgery and other things that we cure as routine at present.

How people aren't more concerned about it I'll never know.

There is also a massive problem with the antibiotics people take everyday without realising - our meat industry routinely gives antibiotics to healthy animals to prevent the spread of diseases. This every day low-level exposure is also contributing to overall antibiotic resistant drugs.

Way back in the 80s I did read something about vegetarians responding better to antiobiotics than meat eaters because our bodies don't have the same low level constant exposure, but I've never been able to find anything about this again, so i may have imagined it.

"The public wouldn't have antibiotics to take if the Dr didn't prescribe."

Apart from buying them OTC abroad, loads of people don't finish the course then take them another time, or take other people's unfinished courses.

Some people do not actually understand the difference between a virus and a bacterium.
You would think the clue would be in the name, but apparently not.

If they were referred to as anti-bacterials, which is what they are, people might be more likely to understand this. The word "antibiotics" doesn't really give any indication of what microorganisms they are active against.

Cretins like my MIL who (a) fib to the doctor to get antibiotics and (b) never finish the course and store them up for when she next has a cold. Obviously, as anyone with half a brain knows, they aren’t remotely effective on colds, but she insists they are on HER colds.

My DH and MIL drive me mad with this! My DH has a condition which when it flares up, once a year or so, the only thing that eases it is AB's. Once it was so bad he got given a 2 month course. He can't even finish a 2 week course without skipping a day so he can go to the pub with his mates or just 'forgetting' (yes he is a manchild). As a result he has quite a few of them in our medicine cabinet and every so often he feels he needs to take them again and so he will - for a few days - not fully treating anything as he hasn't taken the full course and just building up his resistance.

Then if you tell MIL - a nurse who should know better - that you don't feel well, she comes round with antibiotics that her parents haven't used "because they work the same way" as what you need to clear up whatever it is you've got. But they haven't been prescribed to us?

Ugh

I honestly wonder whether this is the place for homeopathic 'antibiotics'... "Yes Mr Smith, these homeopathic 'antibiotics' will be just as effective for your virus as non-homeopathic antibiotics would be. People feel better in a matter of days."

Because (a lot of) people are idiots and unfortunately everything must pander to the lowest common denominator. Plus antibiotic resistance is a real threat, people need to take it seriously.

I know someone who has a stockpile of antibiotics (from unfinished courses) and pops a couple like paracetamol whenever they have a sore throat. Drives me wild with fury but I've tried to explain, to no avail.

I also worked with a woman from another country who said our health service was shit because she couldn't see a doctor for antibiotics whenever she wanted. So when she visited family overseas, she bought up as many boxes of them as she could, brought them home and took them whenever she had a cold or stuffy nose.

She was always ill with something or other, but ultimately ended up really properly sick with a red blood cell condition. I can't help thinking that she shouldn't have pissed around with her natural immune system for all those years.

That's not actually the point, I know...just frustrates me that people think they know better than the medical profession, and are putting the rest of us at risk (of contracting infections which are resistant to antibiotics).

And then, one day, one of these people will give her husband - who happens to be taking statins to lower his serum LDL - some "left-over" clarithromycin for his nasty cough. And he'll die from rhabdomyolysis. And she'll blame someone else.

Yes, great idea MrsTerryPratchett.

Doctors under pressure to prescribe unnecessary AB's should instead give those patients placebo pills. Patient goes away happy, and gets well just as quick, doctors are happy, placebo pills are cheap to prescribe and NHS gets the prescription costs, and antibiotic resistance is kept under control. Win win.

There's a lot of ignorance around the use of antibiotics. I remember a school friend of one of my DDs taking her DD back to the GP three or four times demanding an antibiotic because the girl had a virus and the GP wouldn't prescribe anything. She got her way in the end as the GP got fed up and just gave in. She was so triumphant that she'd got one over on her GP, silly woman.

We had an au pair once who turned up with half a case full of antibiotics that she'd bought in her own country just in case as she'd heard they were difficult to get in England; yes, there's a reason for that.

A rather large portion of the general public dont understand the fact that sometimes you get ill and you just need to deal with it using fluids, pain relief and rest.

Someone coughs once and they request antibitoics.

That's a brilliant idea MrsTerryPrachett.

Only trouble is, I can imagine that giving patients a placebo when they think they're getting an antibiotic, even though they don't need one, might infringe their human rights in some way and I suspect they'd win a payout from the NHS if someone decided to take a test case through the courts.

Oh and most people dont know that antibiotics take an average 3 days to actually work on your system. People who dont immediately feel a massive difference ask for a different type. Or they dont finish the full course or take them as advised

I believe the 'finish the course' rule was now being disputed. It's always struck me as a bit off.

I do know people who share anti-b's though. Idiots.

I've had patients storm out my room when I refused antibiotics. They usually scream "thanks for nothing" or " sorry for wasting your time" in a really sarcastic voice. Only once been reduced to tears by a patient though over this.

Most viruses/infections clear up at about the same time as taking a few days antibiotics so people assume it’s the antibiotics doing the job. They don’t sell them over the counter in Spain anymore. This was stopped a while ago. By overusing them so much damage will be caused but people just can’t see it!

My sister is another one of those antibiotic idiots. She insists on having them for every snuffle or slight sore throat. She did the same with my niece and is doing the same with her grandchildren.

She has not a care for the future and resistance, as long as she's okay now.

She should know better as we were brought up by older parents. Pre-war my mum cut her finger which got infected. My GF saved it with hot bread poultices, but her little finger was deformed.

I'm terrified of resistance as I use catheters and get regular UTIs. However, I get really frustrated as I know that my infections need antibiotics from my history of them going to my kidneys, but I have a hell of a job getting them. I'm with the same surgery as my sister who gets them for everything, but I have to beg!

I've rocked up at the surgery with two samples - one to send off and one for testing there and then, am told oh yes, blood and white cells present, but you'll have to wait for the lab report. Three days later, my UTI has gone to my kidneys and I need hospitalising.

This has happened three times in the past 18 months. I'm even more annoyed as I have a neurological condition and can relapse with infections. My neuro has written to the GP but is ignored.

I joined the register pledging not to misuse antibiotics and never ask for them for coughs and colds, despite having asthma and getting pretty bad chest infections, but I have no idea what to do any more about asking for when I have a UTI.

Anyone here suggest anything? Am I right in asking for them for UTIs? When the doctor asks me if I'm sure I have one, I'm deadly sure. I've had too many to not know the signs.

Anyone else get an upset stomach with them? Then thrush?

I would not be taking them unless I had to. I don't understand those who can't sneeze without demanding them.

Does anyone have the figures for MRSA deaths? Would fact and figures for them hit home for the misusers?

I used to go to India (Goa) and lots of people there in holiday would stock up on antibiotics as well as other medicine while there, as you can just buy it from the chemist, as long as you know the name, they'll sell it to you! Madness.

I totally agree that doctors shouldn't prescribe unnecessary antibiotics, but it's not always as clear cut as people think. There are guidelines, and obviously there's your physical examination, and there are tests you can run, but none of those things can give you absolute certainty. A lot of the time it's a bit of a grey area. If you are a GP who has built up a relationship with a patient (and I'm not defending this) it can be hard to say no to a request for antibiotics. Also how long ago you qualified would also have a bearing, I would say that in recent years there's been a lot more emphasis on antibiotic resistance during doctors' training. Then you have the patients who get angry or who just keep coming back until they get what they want. Or you say no to their request for antibiotics, and then a couple of days later a letter comes in to say that they presented at A&E/Urgent Care the same evening and were prescribed them there.

I also worked with a woman from another country who said our health service was shit because she couldn't see a doctor for antibiotics whenever she wanted. This is, IME, a really common attitude. I believe that a lot more people then you would think stockpile antibiotics while they are abroad.

"Finishing the course" has always struck me as strange. Yes, if you don't keep going till the pathogenic bacteria are zapped then you risk relapsing only with resistant bacteria...but the longer you take abs, the more generations of commensal bacteria (on your skin, in your upper respiratory tract , in your gastrointesinal tract and knocking around the entrance to your urethra) are exposed to them and may develop resistance. I reckon "keep going for a couple of days past clinical cure" is as good a guess as to when bacteriological cure has been effected as any.

So far we have:

• people not finishing the course
• immunocompetent people with viral disease popping abs
• the agricultural industry

put forward as contributors to resistance, but have any big epidemiological studies been done to find out how much these contribute to the problem at the coalface
ie do people with clinical disease caused by bacteria with induced resistance to antibiotics get their history investigated and in contacts swabbed and phage typed (or whatever you call it) to try to work out the source of the resistant bacteria? Is lateral spread common or are most cases of resistance induced in the affected individual by unavoidable repeated use in those with incompetent or suppressed immune systems?

@powershowerforanhour - It's worth reading about the identification and origin-tracing of the New Delhi metallo-beta-lactamase 1 gene (NDM-1): en.wikipedia.org/wiki/New_Delhi_metallo-beta-lactamase_1#Origin_and_spread. Spread was found to occur largely through horizontal gene transfer via plasmids (fragments of DNA transferred from one bacterium to another), resulting in the same resistance emergin in several distinct bacterial species.

emerging