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

[Gem123J]

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!

Is she still unwell this morning?

It's no wonder that antibiotics are becoming less and less effective. People are just desperate for them - Friday morning at work (GP receptionist) I must had had at least 15 patients call in saying they needed antibiotics. I had 2 colleagues booking in the same. It seems a general trend that if you have a cold, you phone the GP ....

I work in healthcare so routinely test myself for covid and have tests at home so I did test her just in case, she was negative, but agreed, they were the symptoms I had last time I had covid, although had an awful blocked nose too! No cough strangely enough!

Yep, this.

OP, as a first port of call given your description, I wouldn’t have said Antibiotics were needed.

Regular alternating paracetamol/ibuprofen for a start would have helped. And not getting her out for a walk when she’s clearly unwell would have also been better.

This statement just doesn’t apply here. DD obviously has more than a cold. I was also following NHS Wales guidelines regarding strep a. And I’m not desperate for antibiotics, I’ve just read many, many articles about GP’s being urged to give antibiotics (to children) in the light of the strep a crisis because it was safer than not to prescribe given that viral and bacterial infections are indistinguishable in the early stages.

Am I the only one who does rush their kids to the GP with every little thing?

You're not listening OP. Antibiotics are in shortage and antibiotics have their own risks and overuse of antibiotics is making superbugs.

You should have skipped your boxing day walk, keep her comfortable and hydrated. Get some lollies or icepops in and let it works itself out. If something else develops then deal with it then.

Where did you read this?

@Hobbitfeet32

she’s fine in herself, has had a little something to eat, has drank a lot, happily playing but does still have a high temp.

You have basically been lying in wait for a doctor to fail you @Gem123J because you want to be treated with the same attention as your friend was.

You wrote:

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

This is the problem with the current situation - some parents will not be happy with any doctor who uses their diagnostic skill to say they child is just experiencing viral. In your friend’s case, I can see why they persisted. That may not be the same for your child.

“she wasn’t happy with the response” - is this TripAdvisor??

…and had husband to take him the following day and they swabbed him and prescribed antibiotics and it came back as strep a.

Good on your friend for persisting, but this was the outcome for them, and their child.

You have basically taken their example as the gold standard for all children who fall ill, and therefore you expected to be swabbed and given antibiotics at the first sign of trouble for your child.

YABU, it isn’t a menu that should be offered on a “standard booking”.

Where are all these articles OP?
In what capacity in healthcare do you work?

For transparency, I am a doctor. I would not say antibiotics were needed by your daughter at this stage.

I would also question why she wasn’t at home, keeping warm, fluids, regular pain relief etc

I agree that it sounds like there is no issue with her care at the moment and its not unreasonable that she hasn't been given antibiotics but given the stories of young people dying I understand your worry. People here are right about the antibiotics though which was your question. They are also right that a Boxing Day walk was probably not ideal - she does need to rest. But again it think you are maybe getting a bit of hard time - sometimes we think a bit of fresh air will do them good but she does probably need rest so her body can fight what she has and get better. I hope she is better soon.

Is anyone commenting here actually a GP/practise manager or someone who is aware of the guidance sent to GPS about the strep A outbreak? Or are you all just commenting about how antibiotics are usually prescribed?

@Quincythequince

I’ve supplied many links in a PP but -

psnc.org.uk/our-news/invasive-group-a-strep-igas-information-for-pharmacy-teams/

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

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.

there are honestly so many of these. I have no idea how it is only me and 1 other poster who has heard about this!

My daughter had the same symptoms as yours. I took her to the Doctors ( she had a temp and a sore throat) I would never ever normally bother the doctors & just assume viral but due to Strep A concerns I called & they wanted to see her. She was then given ABs because the GP wanted to err on the side of caution. Like you say maybe certain GPs do things differently.

So you want something so you can think it works rather it actually working?

Good god OP.
Find something else to main about.
Your daughter feels fine, but you think she should have been given antibiotics on your say so yesterday.

No wonder GPs are leaving in droves. Clearly your articles and google are a better resource than a trained, skilled HCP.

It seems it’s the latter. Being a mother, I am very concerned about strep a and have read up about it so I know the signs etc. to look out for. I’m only following what I have read but it seems I’m being labelled as someone who just wants antibiotics for a “cold”, when that is totally the opposite. I’ve treated many illnesses at home, I’m not one to waste doctors time, but considering what is being advised with strep a I’m being cautious and following the advice, but the “experts” of Mumsnet are penalising me!

This is it exactly - the OP believes they are entitled to a “standard” response from a GP that involves dispensing of antibiotics, and anything less is inadequate. This is because “a friend” wasn’t “happy” with their GP’s response.

It’s the TripAdvisor mentality but extended to healthcare, it’s just frightening.

Did you miss the part where I said I am a doctor?

What do you think a low threshold means OP?

What do you think a usual threshold would be for prescribing?

What do you know about antibiotic use more generally in children?

Quite concerning that medics on here don't know about the guidance.

It’s difficult - on reading it doesn’t sound like there is an obvious locus of infection, so I think the GP was right, at that moment. That said, it doesn’t mean that this illness won’t develop and be easily diagnosed as a bacterial infection, so do be vigilant and go back if you need to, maybe tomorrow when the GPs open again.

If she’s ok in herself she probably doesn’t have an infection, or if she does it’s not raging right now. She needs to stay home and rest, lots of fluids, medicine as appropriate. There is a lot of influenza around which is causing more of a problem for our local hospital than strep now.

is the very high temp something you’ve seen before? One of my DC had form for going over 40 when he had a temp, seemed to be part of how he was made, and at 40.5 he would be less ‘unwell’ than my other child at 39.

I would use a paediatric traffic light system to monitor her, and seek help as needed.

www.nice.org.uk/guidance/ng143/resources/support-for-education-and-learning-educational-resource-traffic-light-table-pdf-6960664333

I honestly wouldn't be too concerned if she is well(ish) in herself. My assumption is that GPS were told this due to abundance of caution rather than it being necessary for the majority of kids. As you say the majority of strep A cases will resolve by themselves anyway, and we don't really test for it too much here so mostly you'd probably just put it down to a cold under usual circumstances.

Why did you take her out for a walk when she is sick?

@Tonsiltrouble

thank you, I’ll screenshot the traffic light system so I can have a look when needed.

This has happened once where her temp was rising, even with regular calpol and ibuprofen, and went up to 40.3 then. This happened October last year. When I saw the GP then he couldn’t think of what exactly was causing it and to keep an eye out. Luckily she did go back to normal a couple of days later, no idea what caused it but she was very snotty and it was green so I assume a sinus infection, she has many of these so I do just monitor and let them get better on it’s own. Although this time she doesn’t seem to be snotty.