To think GP’s are meant to be lenient with prescribing antibiotics?

Gem123J · 2022-12-26T23:41:15+00:00

My DD (4 years old) woke up this morning with a headache, checked her temp and it was 38.6 so gave her calpol at 8am. Couple of hours later she was still complaining of a headache and said her forehead was hot so checked her and she was 39.3 so gave her ibuprofen at around 11am. Checked her temp again before we left the house to go for a walk and she was 38.6 and was happy in herself so we carried on with the walk. While on the walk she was totally fine, happy and running around playing “monsters”! We went for a drive and around 3pm she was very pale, lethargic and just wanted to cuddle and wasn’t herself at all, checked her temp and it was back up and was now 40.1 so gave her calpol and decided to call 111 because she was also complaining of sore throat, headache seemed to be bothering her more because she was wincing and she was also complaining of belly ache, her tonsils look inflamed too. We stripped her down and had a call back off the triage nurse, then the GP and was told to come in for an out of hours GP appointment later in the evening. While waiting for the call back her temp went up to 40.2 and we gave her ibuprofen at 5.30pm. She didn’t want anything to eat but she did manage to drink and had 2 of the baby cucumbers but didn’t want anything else. Her temp went down with the ibuprofen like it had done earlier. She perked up a bit before the appointment and her temp went down to 38.6 and the GP checked her lungs, checked her ears and her mouth but didn’t seem to be concerned about her tonsils and just said it’s most likely viral. I am obviously a bit concerned because her temp had got so high even with alternating calpol/ibuprofen every 2-3 hours (we were told to alternate off her GP last time she had a high temp that was still rising last year). And there have been local cases of strep a and I thought that GP’s were told to have a low threshold for prescribing antibiotics because viral and bacterial infection symptoms are indistinguishable in the very beginning. Obviously I’m going to keep a close eye on her tonight but it is a bit scary when you read stories of children who were told they had a viral infection and were seriously ill a few hours later. My friend took her son to their GP last week and was told he had a viral infection, she wasn’t happy with the response and had husband to take him the following day and they swabbed him and prescribed antibiotics and it came back as strep a. I know not all cases are fatal but should I have pushed for the GP to take a swab? All he said was keep an eye out and if she still has a high temp in 5 days to take her back. Has anyone experienced the same thing lately? Obviously if I thought my daughter was seriously unwell then I wouldn’t be waiting around, it’s just crazy how one minute she looks absolutely awful, but perks up and looks like a different child the next and is just up and down like that!

postcardpuffin · 26/12/2022 23:48

Research shows that most respiratory infections are viral, and that antibiotics have pretty limited effects anyway even for bacterial throat infections in both adults and children (only slightly shortening the duration of symptoms which your immune system is clearing up anyway).

If there is no obvious indication that an infection is bacterial, NICE guidelines are now not to administer antibiotics as a first treatment. I know this is a change from previous generations; but antibiotic resistance is a serious and growing problem, and GPs are now much less inclined towards prescribing antibiotics where not clearly indicated, partly because of this, and partly because the clinical advice shows they are more often not needed than needed.

Dello · 26/12/2022 23:52

postcardpuffin · 26/12/2022 23:48

Research shows that most respiratory infections are viral, and that antibiotics have pretty limited effects anyway even for bacterial throat infections in both adults and children (only slightly shortening the duration of symptoms which your immune system is clearing up anyway).

If there is no obvious indication that an infection is bacterial, NICE guidelines are now not to administer antibiotics as a first treatment. I know this is a change from previous generations; but antibiotic resistance is a serious and growing problem, and GPs are now much less inclined towards prescribing antibiotics where not clearly indicated, partly because of this, and partly because the clinical advice shows they are more often not needed than needed.

Couldn’t have written it better. Mainly don’t prescribe because it will not affect or improve the illness, also risks multiple side effects. Also growing antibiotic resistance and limited new antibiotics being developed. So in the future more will die from what now are easily treated conditions.

Original poster

Gem123J · 26/12/2022 23:57

I 100% understand that. And the only time my DD has ever had antibiotics in the past has been for uti’s. She has frequent sinus infections and I just treat her at home. I just read several articles in the beginning of December about how GP’s were urged to have a low threshold for prescribing antibiotics due to several cases of fatal strep a. But of course this was on the news and we know how they like to scare people! So that’s possibly what’s happened with me! And just thinking of the local cases of strep a etc. I am just a bit concerned.

OP posts:

MargaretThursday · 27/12/2022 00:04

The chances are even if it is strep A that she'll be fine without antibiotics. My girls both had scarlet fever without using antibiotics.

However dd1 had antibiotic resistant pneumonia when she was 8yo. Luckily it wasn't resistant to all antibiotics, but she was on 3 different antibiotics (which was 10 doses a day in total) to make sure it was thoroughly knocked on the head, but we had a scary 2-3 days when it wasn't clear whether even that was going to do anything.

FangedFrisbee · 27/12/2022 00:06

It's literally less than 24 hours though!

IceReckon · 27/12/2022 00:07

DS was diagnosed as viral by gp with the same sudden very high temps, headaches and sore throat. Temp was still going up the same a few days later, took him to a and e when we noticed a rash (impetigo type spots) had started on his legs in the evening and he was given antibiotics for strep as the cause for the throat and rash.
I'd trust out of hours at hospital much more than the GPs in general if you're concerned too.

MintJulia · 27/12/2022 00:12

Keep alternating ibuprofen and paracetamol to keep her temperature down, dose her at regular intervals as far as possible, keep her hydrated as best you can, and monitor her. Try to entertain her quietly at home.

Any significant change, like a rash, I'd go straight to the OOO GP.

Wellthankyou · 27/12/2022 00:21

Going completely against all the other advice….absolutely no disrespect towards other posters but my daughter had tonsillitis regularly as a child and the one time she wasn’t prescribed ABs she was admitted with pneumonia 🤦‍♀️

Original poster

Gem123J · 27/12/2022 07:35

FangedFrisbee · 27/12/2022 00:06

It's literally less than 24 hours though!

I’m just going by NHS Wales guidelines regarding the strep a business - treat at home if your child has the following - sore throat, headache. Contact NHS Wales 111 if your child develops any of the following- fever, nausea, a fine red rash (she had/has a fever). So I followed the guidelines, 111 obviously thought it was serious enough to pass on the the nurse, nurse obviously thought it was serious enough to pass on the the GP, GP thought it was serious enough to be seen face to face!

Some children have died within 24 hours so I would rather follow guidelines even if it’s “literally less than 24 hours though…”

OP posts:

WonkasBooboofixer · 27/12/2022 07:42

Ffs your kid is sick so you drag her out for a walk in cold weather then wonder why she isn't getting better. Paracetamol, rest, fluids, she's pale and lethargic because she is unwell and needs to rest. Her body cannot be active and using energy for walking around etc AND fight off a virus she's too small and her immune system is immature.

InfluenzalA · 27/12/2022 07:43

Gem123J · 27/12/2022 07:35

I’m just going by NHS Wales guidelines regarding the strep a business - treat at home if your child has the following - sore throat, headache. Contact NHS Wales 111 if your child develops any of the following- fever, nausea, a fine red rash (she had/has a fever). So I followed the guidelines, 111 obviously thought it was serious enough to pass on the the nurse, nurse obviously thought it was serious enough to pass on the the GP, GP thought it was serious enough to be seen face to face!

Some children have died within 24 hours so I would rather follow guidelines even if it’s “literally less than 24 hours though…”

Show quote history

It was serious enough to be seen f2f - by a skilled, trained professional. That's why you went, to benefit from a trained HCP examining your dc. It's not a vending machine for abs.

By your logic, you could argue everyone should be given antibiotics all the time.

They are a prescription only medicine, with side effects and issues, not only for the patient but wider society if over used. GPs have the very difficult responsibility of trying to manage their appropriate use in the face of relentless uneducated demand.

It's horrible when DC are poorly, but you've had her seen v quickly, you're managing the temp, you have advice. Hopefully she will get well v soon.

Itstoocoldoutthere · 27/12/2022 07:45

WonkasBooboofixer · 27/12/2022 07:42

Ffs your kid is sick so you drag her out for a walk in cold weather then wonder why she isn't getting better. Paracetamol, rest, fluids, she's pale and lethargic because she is unwell and needs to rest. Her body cannot be active and using energy for walking around etc AND fight off a virus she's too small and her immune system is immature.

This is the bit that struck me as wrong. Do not take a sick child with a temperature out for a walk! Rest, fluids and paracetemol.

girlmom21 · 27/12/2022 07:46

You don't want to have to give children antibiotics if they don't need them. A doctor has told you she doesn't need them. Treat her as they've suggested.

MrsDoyle351 · 27/12/2022 07:49

WonkasBooboofixer · 27/12/2022 07:42

Ffs your kid is sick so you drag her out for a walk in cold weather then wonder why she isn't getting better. Paracetamol, rest, fluids, she's pale and lethargic because she is unwell and needs to rest. Her body cannot be active and using energy for walking around etc AND fight off a virus she's too small and her immune system is immature.

Basically THAT.

If her temp has been above 38.5 in my mind, it's going to take longer than a few hours to get better. The GP has had a look at her at least. Why not follow the advice >?

Krakenwakes · 27/12/2022 07:51

Why were you taking your sick child out for a walk and then a drive? And constantly taking her temperature? Just stop it.

Butitsnotfunnyisititsserious · 27/12/2022 07:52

WonkasBooboofixer · 27/12/2022 07:42

Ffs your kid is sick so you drag her out for a walk in cold weather then wonder why she isn't getting better. Paracetamol, rest, fluids, she's pale and lethargic because she is unwell and needs to rest. Her body cannot be active and using energy for walking around etc AND fight off a virus she's too small and her immune system is immature.

This is the part that stands out. Why on earth did you take your sick child out? Talk about making her worse.

Hobbitfeet32 · 27/12/2022 07:53

I’m surprised you would take her out for a walk when she had a temperature and that you also called the doctor after she was ill for a few hours only.

gogohmm · 27/12/2022 07:54

Those are the exact symptoms DD's boyfriend has now, he has covid!

Oysterbabe · 27/12/2022 07:56

A doctor who has actually seen your child thinks she doesn't need them. They are better placed than us.

Brunilde · 27/12/2022 08:01

Actually based on my experience I'd agree with you. Not going to argue over whether they should or not as I'm not medical but I took my DS in as I couldn't get his temp under control even after alternating ibuprofen and Calpol. I was certain it was viral so wasn't really pushing for antibiotics but the GP told me they have been told to have a very low threshold for prescribing antibiotics because of the situation. So although most likely viral he was given them. Maybe it differs by area?

Jimboscott0115 · 27/12/2022 08:02

There's a couple of things at play here OP, firstly it's that there is absolutely nothing in your description that would warrant me and many others even asking for antibiotics. Most of the types of infections you're discussing are viral rather than bacterial so antibiotics aren't really going to help. There are a certain generation orlf people who have this impression that antibiotics are the be all and end all of treating children yet most of us wouldn't have had them as a matter of course when we were younger soni find this a little odd and it's likely due to the proliferation of using online diagnosis etc rather than common sense when a child is Ill.

The first issue above directly leads to the second. We simply cannot give antibiotics out willy nilly because we're becoming immune to some of them (or bacteria is) and given most of the ones we used have been around a long time, there's a real danger that most bacterial infections will be resistant to antibiotics. Clearly this is evolution at work but overuse is one of the reasons this has happened so I see antibiotics as something you take when seriously ill now rather than a day to day treatment option like it once was and I think that's sensible.

Original poster

Gem123J · 27/12/2022 08:03

InfluenzalA · 27/12/2022 07:43

It was serious enough to be seen f2f - by a skilled, trained professional. That's why you went, to benefit from a trained HCP examining your dc. It's not a vending machine for abs.

By your logic, you could argue everyone should be given antibiotics all the time.

They are a prescription only medicine, with side effects and issues, not only for the patient but wider society if over used. GPs have the very difficult responsibility of trying to manage their appropriate use in the face of relentless uneducated demand.

It's horrible when DC are poorly, but you've had her seen v quickly, you're managing the temp, you have advice. Hopefully she will get well v soon.

Show quote history

It wasn’t my logic that everyone should be given antibiotics all the time. I just read the news and saw many articles about strep a and how GP’s were being told to be lenient in prescribing antibiotics because viral and bacterial infections were indistinguishable in the beginning.

www.gponline.com/gps-told-low-threshold-prescribing-antibiotics-possible-strep-cases/article/1807142#:~:text=GP%20Locums-,GPs%20told%20to%20have%20'low%20threshold'%20for%20prescribing%20antibiotics,in%20possible%20strep%20A%20cases&text=GPs%20have%20been%20urged%20to,about%20rising%20levels%20of%20cases.

www.express.co.uk/life-style/health/1705936/strep-a-cases-increase-uk-health-antibiotics-gps/amp

www.publichealth.hscni.net/news/public-urged-be-alert-signs-group-strep

and there are many, many, many more. So it’s not my logic, as I’ve previously mentioned my DD has had many sinus infections that I’ve treated at home, no antibiotics. She’s only ever had antibiotics for severe uti’s.

OP posts:

Morph22010 · 27/12/2022 08:03

There is a shortage of antibiotics at the minute, especially in medicine ie. Liquid form, if they set the threshold too low there won’t be any left for the people who are much worse for longer

Quincythequince · 27/12/2022 08:04

You didn’t properly alternate every two hours though did you.
It’s right there in your post…

Original poster

Gem123J · 27/12/2022 08:05

Jimboscott0115 · 27/12/2022 08:02

There's a couple of things at play here OP, firstly it's that there is absolutely nothing in your description that would warrant me and many others even asking for antibiotics. Most of the types of infections you're discussing are viral rather than bacterial so antibiotics aren't really going to help. There are a certain generation orlf people who have this impression that antibiotics are the be all and end all of treating children yet most of us wouldn't have had them as a matter of course when we were younger soni find this a little odd and it's likely due to the proliferation of using online diagnosis etc rather than common sense when a child is Ill.

The first issue above directly leads to the second. We simply cannot give antibiotics out willy nilly because we're becoming immune to some of them (or bacteria is) and given most of the ones we used have been around a long time, there's a real danger that most bacterial infections will be resistant to antibiotics. Clearly this is evolution at work but overuse is one of the reasons this has happened so I see antibiotics as something you take when seriously ill now rather than a day to day treatment option like it once was and I think that's sensible.

@Jimboscott0115

I completely understand that but from what I had read, GP’s were urged to have a low threshold for prescribing given the strep a business, as I’ve already answered twice.

OP posts: