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!

I know not all cases are fatal

Thankfully very very few cases of Strep A lead to iGAS (the invasive form). In most cases, no treatment is required - Strep A is linked to sore throats, scarlet fever & cellulitis for example, and treatment given accordingly.

Sadly, there have been some deaths from invasive Strep A this year, but for the vast majority with Strep A, no treatment with abx is needed or is useful.

Nothing about your daughters symptoms, in the absence of you even administering her cal pop and nurofen at correct and regular intervals, suggested antibiotic use.

If you had done the right thing by her re home remedies, fluids, rest etc and it persisted, then maybe it would be considered after a follow-up appointment.

I don’t get GP guidance, but my friend who is managing partner in his own practice, has said this absolute neuroses around prescriptions for viral infections in kids, is out of control this year and he thanks the Daily Mail.

The guidance DOES NOT tell GPs to just prescribe ab’s Willy nilly.

Having the bar set low for prescribing antibiotics doesn’t mean they give them out when their clinical judgement says they aren’t needed. Even if it is bacterial in most cases things like throat infections will be self limiting and don’t need treatment beyond rest and fluids with some paracetamol as needed.

Oh OP, you’re getting more of a hard time here than you deserve. We had a letter from the county via school which urged parents to seek medical help promptly for high temp/ sore throats and that children shouldn’t return to school until 24 hours after’ starting antibiotics’. This sort of thing plus what’s been said in the media does give the impression that antibiotics will almost automatically be given for a high temp and sore throat.

I wouldn’t be concerned if your DD seems fine in herself most of the time but don’t hesitate to see another GP if she is concerning you at any point.

She wasn’t sick at the time and her temp had gone down, it was the shortest walk ever just for some fresh air, which she enjoyed, it wasn’t even a long walk, she wanted to play “monsters” more than anything. I would never take her out if she was sick, yes she was sick a bit later after the walk, pale, tired, high temp. Obviously I won’t be taking her for any walks again until I know she is completely back to normal, lesson learned, but children do go up and down, or my DD did yesterday anyway, it’s hard to know what’s best to do and not always easy to get an active, energetic 4 year old to be lazy on the sofa.

If you are concerned take her to see a different doctor and explain your concerns.

Also let her rest today, don’t take her on any more walks when she is this ill.

OP from your links, you've missed the next relevant part:

asked to have a low threshold to consider and empirically prescribe antibiotics to children presenting with features of GAS infection, including where secondary to viral respiratory illness.”

'Presenting with features of GAS infection ...'

Your DD is not, so the low threshold isn't required. I hope she feels better soon.

You came on to ask.
Most people on here- normal, caring
mums, who also want the best for their kids and have treated many illnesses at home too, also disagree with you.

You don’t like the answers you’re getting. Why ask the question then and why not appropriately care for her yourself? You didn’t do that yesterday, but somehow the Doctor is at fault?

OK OP, I understand you are concerned about strep a. However:

Your dd responded to paracetamol and ibuprofen yesterday and appeared quite well when dosed, only becoming unwell as the effects of the medicine wore off. She also drank a little and ate two little.cucumbers.

The temperature is responding to the correct medicine given regularly. Today she has eaten and has drunk a lot.

When dosed she is behaving normally.

If she were very ill she would continue to be unwell despite the medicine and would not be eating or drinking. She may also be vomiting.

She most likely has a viral infection, ? mark flu.

She needs to be kept in the warm for a few days, dosed on paracetamol/ibuprofen and offered drinks and light meals.

If the temperature stops responding, she gets a rash, doesn't like the light, stops eating and drinking then take her to A&E.

The bar for AB's may have been lowered. However, your dd does not meet the lowered threshold. You were very lucky to be seen by a Dr at all. The Dr has provided advice and reassurance. Absolutely the right thing to do.

I'm not a Dr or nurse OP, just a mother with dc in their mid/late 20s. I would not have taken my DC with the symptoms you describe to the Dr. Neither would I have taken them out on a jolly non essential walk.

Argh @Gem123J why do you have to yell at another poster on here?

Also you fail to understand that guidelines are not direct mandates instructions to all GPs to take the same action in every little instance. They are guidelines. Though to be honest I can see from how you write that this whole paragraph and its inference is wasted on you.

Anyways - if you have read so much about it, and you know the “guidelines”, could you tell us what the GP said when you challenged them on their “failure” to apply the recommendation in the guidelines?

@Quincythequince

Leave OP alone - she doesn't need to be berated by you 'for not looking after' her DD.

She's a caring, concerned mother.

I don't agree with her re the antibiotics but she doesn't need your rude posts.

@ItsNotReallyChaos

thank you. I’m honestly just following the guidance by NHS Wales which the headteacher of DD’s school sent a poster of. And yes, what I’ve read in the media. And mainly because my friend, who is a nurse, was told her son had a viral infection but she asked the GP to swab her son and he did test positive for strep a and had antibiotics. I’m not saying the same should have been done for my daughter, and I’m happy because she’s fine in herself today and I will just keep an eye out for a rash etc. it’s just a bit concerning isn’t it because so many children have died within hours of falling ill.

Oh and just to add that I’d absolutely take my DD out for a walk if she was unwell, just as I’d go out for fresh air myself even if unwell. I don’t understand people’s horror at taking a mildly unwell child out for a walk.

I feel anyone who says antibiotics don’t do much for throat infections has never had strep throat.

Ive had it at least 4 times and after the first day it’s like someone’s put a fire out in your throat.

But I wouldn’t have taken a child out the same day they had a temperature

OP, your response here is in line with your irrational reaction to not being given what you want by your GP.

Your daughter, when assessed, didn’t need them. And hopefully she recovers just fine. Nothing about your daughters symptoms indicated the need for antibiotic treatment.

The GP bashing threads on here are something else and I feel very sorry for GPs.

Don’t get caught up in the Daily Mail Strep A hype either - scarlet fever has pretty textbook symptoms. iGAS is worrying but seems to be more likely if children have other vulnerabilities (not exclusively) and doesn’t necessarily follow on from SF, or if it does it can be sometime after. Strep A itself is a bacteria that lives on many of us, most of the time.

FWIW, one of my children did once become very unwell with sepsis from an infected lymph node. He saw our family GP three times that week and an out of hours GP. He was prescribed antibiotics (second visit to our family GP) when an infection site became clear, though the infection was aggressive and IVs were needed. Later, the family GP apologised to me because he was worried he ‘missed it’ - I don’t believe that he did, when he first saw my child there was no obvious infection site, and nothing to be done but watch and wait. I do think the ooh GP missed the opportunity to prescribe, the large lump in his neck was the sign. The family GP did prescribe next morning but it wasn’t quick enough and he had to admit him the following day. He did make a full recovery.

I think it helpful if we view our role as parents to seek medical advice when concerned (as you did) but realise that in that moment we are just making sure that the treatment we are already giving at home is enough. I think GPs are already very quick to prescribe if they see a reason.

I didn’t challenge him on his “failure”, because contrary to what you think, I do trust what he said, I just simply said I was concerned because of what I have read and was just asking for advice if someone has had the same experience.

Capital letters did seem rude, but don’t you think sarcasm and what he/she said was rude also? I’m having to constantly repeat the same information and having assumptions made about me that are totally false.

What @RosesAndHellebores said.
Very unfair to GP bash.

I totally understand you OP and have read the same about the threshold for ABs being lowered at the moment.

I would think of it this way. Your daughter saw a doctor who at that point in time given her symptoms and the wider context of the Strep A outbreak, still decided that she doesn't need antibiotics.

However as your daughters advocate and again given the wider context of the Strep A outbreak you should not hessitate to take her back for a new look if things don't seem right.

Sometimes parents just can't win. If we stay informed and get what knowledge we can of current dangerous illnesses then we are berated for playing Dr Google when we have concerns. But then at the same time we are told by doctors to "keep an eye out for anything" and expected to know if itsa problem or not. Its really tough and feels like a huge responsibility to get the balance right.

I have not been rude at all.
But OP demanding antibiotics and suggesting her DD meets the threshold for them, when not even administering basic at home treatment properly, despite focussing on apparent GP advice from central government sources, is a bit rich.

My friend had someone threaten to kill him last week of his sick note wasn’t renewed - irrational patient behaviour because of Doctor is slowly on the increase; thank god I don’t have to deal with it.

doctor refusals

Do you suffer from health anxiety OP?

I know what you mean about the guidance OP and understand what you are asking, and why.

Unfortunately, however, I think that the only way to resolve this would have been to have politely asked the GP at the time why their recommendation didn’t seem to fit with what you had read. He or she could then have explained their thinking to you with reference to your daughter’s specific symptoms, and hopefully given some reassurance.

I hope your DD feels better soon.

I have not been rude at all.

I disagree. It's possible to take a different opinion to OP's (I have) without denigrating her care for her DD (which you did).

@ItsNotReallyChaos

You go by how they are at the time don’t you. Not all children are the same, some want to be outside. I obviously would never take her out if she appeared very ill. But at the time she had heaps of energy, her temp had gone down, she had been playing in the house all morning anyway so not bed bound, and she was eating at the time. A little later she was sick, very high temp, not eating, very pale and lethargic, happy to lie on the sofa then so that’s what we did.