To have expected GP to prescribe antibiotics?

[CathyandHeathcliff]

My 12 month old DS has been out of sorts for a few days. We took him to the GP this morning as he’s been really whingey overnight lately, especially when lying down and he’s been crying a lot on and off. At first we thought it was his teeth. However because he’s been pulling at his ear we wanted to check if it was an ear infection. The GP checked him over. His temp was 37.2. She said the inside of his ears and throat were red. So I’m assuming that indicates an infection? But she didn’t prescribe any antibiotics. She just said they “looked a bit red, keep an eye on him and bring him back if it gets any worse”
And that it was an “unspecified viral infection”.
I always thought they prescribed antibiotics for little ones with ear infections or am I wrong? I didn’t get a chance to ask anymore as we were pretty much pushed out the door ready for the next patient.

The temp isn’t very high, and isn’t feverish. I’ve spent a bit of time recently with paediatricians as my wee one has taken a few nasty infections, and they said to me that 37.5 and up is kind of thinking about being on the way to a fever, anything over 38 is classed as a fever. What is also learned is that the higher it goes doesn’t necessarily mean the child is sicker - I always thought the higher it went the worse it was, but apparently not!

37.2 is fine, so please don’t worry too much. Plenty of fluids and rest and I’m sure they will be feeling better soon.

He has a viral infection & the doctor was right, it's gpfir his sake too. If ever he needs antibiotics for a serious infection in future, there is less risk of them not working.

The healthy body can deal with minor viral infections & bacterial infections on its own, the temperature etc is the body doing that

Antibiotics wouldn't usually be prescribed in this situation. Bring them back in a couple of days if there is no improvement is standard.
Ds has antibiotics for all signs of an ear infection but his are atypical (bacterial but no temperature) and have been going on for years.

You need to trust your GP.
They WILL prescribe antibiotics if they think they're needed.

My DS presented with NO ear pain just dizziness to the point of not being able to walk (I had to get a wheelchair to get him from the car to the waiting room).

Slightly raised temp at that point. Antibiotics prescribed. That night his fever went through the roof. He was delirious. The meds kicked in by the next morning.

The GP knew what he was doing.

Both ears red is usually viral. A bacterial ear infection usually one ear is fine and the other is very red/bulging. Even then, 50% of bacterial ear infections will get better in 48 hours with just paracetamol. Sounds like you've got a good GP @CathyandHeathcliff

As other posters have said, antibiotics are only any good for a bacterial infection. Only cure for a virus is rest, fluids and time, so yes, YABU to expect antibiotics in this case if the GP told you it was a virus.

GPs have been giving in to pressure from patients for antibiotics for years, which is part of the reason that we're experiencing higher levels of bacterial resistance to them.

If your GP says don't take them, they've got good reason, although still monitor your child's condition and take them back if it gets worse - secondary bacterial infections which weren't there to start, and can't be predicted, can follow viral infections.

This leaflet gives some good information regarding what to do:
www.wales.nhs.uk/sitesplus/documents/888/Treating%20your%20infection%20EAAD%20leaflet%20%28English%29.pdf

@DontMakeMeShushYou

It's not people that become immune to antibiotics - it's that the bacteria become resistant. Over-prescribing antibiotics puts us all at risk.

Yes, that's what I meant

It is always worrying when little ones are poorly but it sounds like the right call not to give antibiotics. There seems to be a view among some that they should be given 'just in case' but as has been said that risks resistance and no drugs are completely harmless, there are always risks of short term and long term side effects.

Are you being unreasonable for expecting them to prescribe antibiotics that wouldn't work for his current problem, but that could potentially stop them working for him for something serious in the future? Umm.. yes?

She said the inside of his ears and throat were red. So I’m assuming that indicates an infection? But she didn’t prescribe any antibiotics. She just said they “looked a bit red, keep an eye on him and bring him back if it gets any worse”
And that it was an “unspecified viral infection”.

Never assume! Especially as you’re not a doctor... viral infections don’t need antibiotics, and the doctor can’t see any evidence of a bacterial infection.

Sucks when babies are ill, and ideally you’d be feeling reassured by the check-up not unsettled, but if you don’t understand something please just ask again while you’re there. Don’t expect medication on every visit, though - it can do more harm than good.

Antibiotics won;t work for viral infections, and bacterial usually has MUCH higher fever (over 38/39), and even then a high temp is something they won't do much about until 4/5 days in, and if the baby does not have any wrt nappies. Red throat is normal in infections too. Be glad the doctor has not unnecessairily prescribed antibiotics.

YABU. It sounds viral. Antibiotics won’t help at all.

YABU - who are you to expect to be prescribed something specific when the GP, an actual medical professional who has assessed the patient in person, has said it isn’t suitable?

Especially with antibiotics which are well known for being over used/prescribed when unnecessary. There’s signs at most NHS locations (whether that’s a practice or a hospital) on antibiotics and how you won’t necessarily be given them.

OP I get that you're worried about your DS but treat your GP.She is trying to use antibiotics responsibly as they are precious and really in an ideal world should only be used in the case of a cultured bacterial infection but at primary care level we don't have these facilities.

Monitor your DS,take his temp every four hours,if it's higher than 37.5 give him calpol if after two doses it doesn't come down I would ring OOH or ring the GP as appropriate.If you notice any discharge from his ears do same.Hope he gets better soon

My sister was refused by a GP antibiotics when she had a bad ear infection. Was told to steam her ear. It got worse and gunk started coming out. OOH gave her antibiotics.

GP's are trying to crack down on antibiotic use. It's amazing how many people who have a cold demand antibiotics when they will do nothing, other than maybe some side effects.

Antibiotics won’t work if a viral infection.

Swollen glands can cause sore ears and if he has been pulling at them then that explains the redness. Swollen glands are common symptoms of viruses so nothing that antibiotics can do. Prescribing antibiotics unnecessarily is dangerous. Antibiotic resistant bacteria is one of the biggest fears in the medical world right now.

Sounds like a virus to me. If you give him antibiotics unnecessarily now he will be amongst those who will not have any antibiotics that work on his infections in the future due to the upcoming antibiotic resistance crisis. I wrote my thesis about this 30 years ago and it really annoys me how we have just ignored it until there's no way to avert a crisis 😠

I think YABU. Why would doctors give out antibiotics based purely on the child's age? I don't think that's the case.

There are 3 possible reasons for not prescribing antibiotics.

1. Dr thinks it is an upper respiratory tract infection (can also affect the ears)- almost always viral and so antibiotics will not treat the infection but can give side-effects and expose a young child to antibiotics they do not need. Also increases risks of antibiotic resistance. So not good for anyone. Perfectly normal practice.
2. Dr thought it was unlikely to be a significant infection but was unable to be sure if bacterial or viral, so held off antibiotics but gave you worsening advice which was to come back if your child deteriorates or you have concerned and he can be checked over again. Perfectly good practice.
3. the Dr does believe it is a mild bacterial middle ear infection (otitis media) but as child systemically well and there is no significant build up of fluid behind the ear drum/bulging of the ear drum (it's just a bit red) that antibiotics are not indicated. This is because guidelines state that in absence of evidence of systemic upset or significant effusion/perforated ear drum or suspicion that a perforation is likely, then antibiotics are not indicated because they reduce the duration of illness by 24 hours, or slightly less. You run risks of side-effects etc for very little benefit. You would be better to let the illness run it's course, unless the child deteriorates- again, you have been given advice as to what to do if you think the child deteriorates.

In the past Dr's gave out antibiotics too easily, so it is understandable that so many people expect to be given antibiotics for mild illnesses (which can make you feel rubbish) or viral illnesses (which can also make you feel really unwell). There have been lots of attempts to educate the public, but these things do take time. Not helped by the fact that a small proportion of GP's still give it out too readily (not knocking GP's- they have a tough job, increasingly so)- often I think to get people out the door quickly without having to enter into an argument/long discussion because they don't have enough time per patient and ever increasing workloads. BUT we do really need to be more careful about antibiotic use than in the past for everyone's sake. Its not just because doctors like to be difficult or watch people suffer when we could help. And yes, Dr's will sometimes get it wrong- nobody is pretending we are perfect- but sometimes it is also not possible to anticipate which patients will deteriorate but would not have done so with earlier antibiotics- it's not an exact science. Which is why Dr's give advice to come back if worsening. I am a Dr- not a GP, but I do know they get a lot of stick for not giving antibiotics on demand (often unfairly, IMHO).

The GP diagnosed an “unspecified viral infection” and, quite correctly, didn't prescribe anti-biotics as they do not cure viruses.
Therefore, YABU to have expected anti-biotics. If it had been a bacterial infection then anti-biotics would have been prescribed.

@CathyandHeathcliff

You're probably feeling a little bruised by the responses in this thread and I hope your lo is feeling better now.

I spotted this article today and thought of this thread.

I assumed ear infections = antibiotics for little kids too op! My dd had a nasty infection with discharge once and got the good old banana medicine (penicillin) so when she had a sore ear again I took her back expecting the same. Gp explained to me that she would probably fight this one off herself as ear was just a bit red, and the gp was right she did. Hopefully your baby will be better very soon, just make sure you take him back if he gets any worse.