antibiotic resistance and GPs

[M3lon]

AIBU to simply not understand the approach of GPs to infections given the constant news about rising antibiotic resistance?

My DD had a skin infection and we had 1 antibiotic cream and 4 different types of antibiotic medicine before they decided to test it to see what it was.

After all that you won't be surprised to hear the infection was fungal...but what is the logic of giving out 5 different antibiotics before testing to see what the infection is?

I'm baffled as to how that could possibly be cost effective...especially as my DD doesn't pay for prescriptions.

Testing is usually not done because it takes so long to get the results back that most infections will have cleared by the time you have the results. In most cases a broad-spectrum antibiotic will clear it up.

If you test, then you either have to delay treatment until you know what it is (not ideal when its severe enough to need treating, generally better to give a broad-spectrum AB) or treat regardless whilst waiting for results (that are then usually unnecessary because it's cleared before you know the results).
It's a numbers game. Testing at the start obviously would have been best for your daughter, but in most cases it's not the best strategy.

The test took 3 days to return. That is less time than we were on treatment 1 of 5 though?

I wonder if the 'when is it worth testing' protocol doesn't realise how fast the turn around is these days...or doesn't understand the coming antibiotic resistance apocalypse?

Hmm, I don't know then. I work in a related area, so have some knowledge but it's not my area of expertise. I am sure those writing the guidelines are very aware of turnaround times and the dangers of antibiotic resistance though - they will be experts in the field and quite possibly practicing doctors as well.

It's possible that it was an expedited test? That sounds unusually quick for results. And they were probably able to rule quite a lot out from the fact that so many different things had failed. That's quite a different situation from blanket testing at the start.

Testing is usually not done because it takes so long to get the results back that most infections will have cleared by the time you have the results. In most cases a broad-spectrum antibiotic will clear it up.

if it clears up before test result is back no treatment was needed in the first place...

I'd imagine that in cases like that they take an educated guess that its so much more likely to be treated with antibiotics, that for the majority of people testing then treating would waste time and money. Obviously doesn't work for situations like your DD's but maybe that's rare enough for it not to be worth testing all the time first.

Sounds like they did a culture? In which case there’s no such thing as an expedited test because you’re waiting for bacteria to grow, there’s no way to make them grow faster. If the culture is negative you’ll know sooner than if it’s positive because then you have to wait for enough bacteria to grow to be able to identify them. 3 days sounds about right for a negative culture, more like 5 for a positive culture with an identified bacterium and the resistance pattern.

As PP has said, if an infection looks like it is bacterial and needs treating, then you can’t wait for days and you have to just treat it, and the best way to do that is with a broad spectrum antibiotic, possibly switching to a narrower spectrum antibiotic once it’s clear what is causing the infection. Unfortunately in your DD’s case it was fungal, but in many cases those kinds of infections will be caused by bacteria and the antibiotics will work well.

Also different GPs have different attitudes to antibiotics, some will throw handfuls of amoxicillin at anyone with a sniffle, and some are much more careful.

Has it actually cleared with treatment for fungal infection?
Skin swabs are notoriously unreliable and very often grow fungal cultures as we all have fungus on our skin. Our microbiology team tell us not to treat swab results for staph aureus or for anything fungal as they're such common skin commensals.

flamingo given what they found I am worried about that too. We are on day one of fungal treatment so no idea if it will be effective yet.

Testing for microbes took 3 days, culturing did take longer - maybe 7 days.

The first line of treatment is just the topical cream. I feel it was perfectly reasonable to treat with that without finding out what it was. But when that didn't work then why not test? Or after the first course of ABs didn't work...

4 oral courses just seems bonkers...its obviously not your first or second or third guess is it?

Perhaps because GPS know how little prescribed antibiotics add to the real problem, which is those used in Farming and the amount of countries that sell them over the counter.

I've known two toddlers to end up in hospital, because of over cautious GPs. It needs questing, when it isn't even on the radar of some regions of the World.

you can get personal drug resistance too. Mt DD just got exposed to 5 separate antibiotics for no benefit to her or anyone else. If she has any MRSA, it will now be more significant in the bacterial make up of her skin than it was before.

Antibiotic resistance is everyones problem..it really isn't all about farming.

you can get personal drug resistance too.

No you can't. Antibiotic resistance comes about because the AB's kill 99% of bugs, leaving the 1% with some natural resistance to breed the next gen - which are now more resistant. Rinse and repeat.

I suppose you could do this with people by throwing nerve poison around a medium size city, then getting the survivers to pair off and make babies, but I don't think that'll get past the ethics committee review.

No, antibiotics are resistant to certain bacteria not to individuals.
About 35% of the population is colonised with MRSA and it generally does nominate no harm to the otherwise healthy.

you can have personal resistance...which means that the bugs on your particular body are highly resistant because of all the various anti-biotics you have been exposed to. That is what personal antibiotic resistance means....

I have a heart condition that means I have to have a lot of antibiotics. I have to keep a record of what I've taken and at which times to manage the likelihood of me producing multiply resistant bacteria, that would then kill me if an infection developed.

Its mostly about cycling between different categories of antibiotic so that nothing is still around that was treated with one, when you hit it with the next.

The 5 rounds my DD got in 5 weeks is really massively bad practice.

No that is incorrect. There is no such thing as personal antibiotic resistance. Antibiotic stewardship in UK means very tight antibiotic prescribing in line with local and national guidance.

The bacteria on your body might well be resistant. A third of people are colonised with MRSA. That is not because you are resistant but because there is a high incidence of MRSA in the general population. It’s common and generally does no harm.

Antibiotics are rotated on local prescribing guidelines to reduce the risks associated with resistant bacteria in vulnerable people. You should generally be given antibiotics in line with the trust and CCG policy. That is likely to not always be the same antibiotic. You aren’t resistant the bacteria may become so.

This gives detailed easy to understand information on antibiotics.

bsac.org.uk/wp-content/uploads/2013/07/Stewardship-Booklet-Practical-Guide-to-Antimicrobial-Stewardship-in-Hospitals.pdf

cherry I already said I was talking about the bacteria not the person. If one person is exposed to multiple antibiotics there is a greater chance of a future infection they have being resistant than for a person who has received no antibiotic treatments.

I don't know why you are so adamant that this doesn't happen...it does.

It is not wise as an individual to be taking unnecessary antibiotic courses.

I agree- the testing should have been done once the first lot of antibiotics didn’t work.

The doctors and dentists I see offer me antibiotics at the drop of a hat. I also get a lot of ‘just incase’ antibiotic prescriptions, when the dr leaves it up to me to decide if my child (or myself) needs them or not.
I’ve also taken far too many recently and it makes me panic

I'm just glad they seem to have changed all the rules about antibiotics with dental treatment recently....I hit 5 doses in one month once...that broke guidelines but hey.

M3lon, give me your evidence base and I might change my mind.

What are the new rules regarding dental treatments?

New rules mean no more prophylactic antibiotics for fillings or hygienist appointments.

I used to have to take a massive dose an hour before basically all dental work...more than once I puked on the dentist as a result.

Not sure that fed into national policy though!

In a not very interesting update...I have now gotten the same rash...probably from the same source rather than from my DD. And guess what?

Do you think the doctor was interested in my DD's progress and diagnosis? No, not at all. They have insisted I follow the same path of first line treatments with antibiotics even though its blatantly the same infection that failed to respond with my DD.

Honestly - the system is stupid beyond belief.