Do A&Es hand out too many antibiotics?

[Busby88]

I had to take my DS to A&E tonight (off the back of a call to 111) and he was one of four kids in the space of about 30 mins who was given antibiotics after a quick consultation and sent on their way.

Mentioned it to a friend and she said that she thought everyone knew if you want antibiotics to go to A&E.

Is this a thing? Do they just hand them out to get people out of A&E and free up space?

Our GP is very reluctant (understandably so) to prescribe antibiotics and I never push for them as I know how many bugs are viral.

I also now feel bad for taking DS to A&E when it seems like something the GP could have just done but he was iller than I’ve ever seen either kid and 111’s advice was to go to A&E within the hour!

111 Always advise you to go to A and E.

What did they diagnose as being wrong with your son? Was it something that will be helped by the ABs?

@Chowtime Oh I know they usually do, realises that early on with my first but this time around I was worried, but not worried enough to take him in until they told me if that makes sense.

They said he has a chest infection, obviously they’re the experts so not disputing this but I just feel like everything everywhere else says most infections clear up without antibiotics, whereas this hospital was giving them out to almost everyone.

People who go to A&E are likely to be in more pain / have more severe symptoms than someone who goes to the GP and therefore more likely to need AB. As long as your child doesn't have them too often it'll be fine as long as they fix the problem.

I hope your son starts to feel better soon.

Was there anything else you wish they had done?

@Singleandproud That makes a lot of sense, didn’t think of it that way.

I would say that you have no idea why the others were there and that if your child has a chest infection they were right to give the antibiotics! Chances are, if 111 have sent the other children it's highly likely they have an infection too!

@Chowtime Thank you that’s kind. I guess I just wish they’d done more than one set of observations on him so they could see his stats over a period of time because he keeps rallying and then deteriorating, but the doctor saw us super quick and all the staff were doing a great job with a huge number of poorly children so no complaints, I guess it would have just helped my peace of mind!

@EMary12345 Oh I know it’s none of my business, I was just sat next to the nurse’s station so they were making them up right next to me one after the other like a little conveyor belt, that coupled with my friend’s comment around people go to A&E because they know they’ll get antibiotics just made me ponder it

It's also possible they went to the GP, got told to "watch and wait" and make another appointment / A&E if thing gets worse.

Simple things like an ear infection can be left ...until they can't, and if they don't clear up on their own and are left could cause hearing loss.

Sepsis is a big risk and something A&E are also on the lookout for trying yo prevent.

Generally it's true, but ultimately I wouldn't say that's a positive of going to A&E. If you goto A&E you're likely to be seen by a less experienced Dr than at the GP and so they're more likely to err on the cautious/defensive side and prescribe. It's really vanishingly rare that children should need antibiotics, even in GP they've vastly over prescribed - some studies put 88% of prescriptions for antibiotics in certain conditions being unnecessary (ear infections), with an average of 20% across the board inappropriate.(https://www.google.com/amp/s/amp.theguardian.com/society/2018/feb/27/fifth-of-prescribed-antibiotics-are-unnecessary-study-finds).

There's also a time factor- it's more time consuming to evidence in assessment, documentation, and in longer conversation with parents that typically follows a DX of a self limiting infection not requiring antibiotics. As opposed to the much simpler prescribing; balancing the harm of the likely unnecessary antibiotics against the sheer volume of patients you're reviewing missing the child that really needed them.

There's also for want of a better word optics - a parent that's taken their child to A&E could be said to believe theyve seem something that makes them question their child might have a life threatening illness, as opposed to going to the GP which could be said seeking reassurance/simple treatment. It's like calling 999 instead of 111 plays out in transport decisions by the ambulance service.

People who go to A&E are likely to be in more pain / have more severe symptoms than someone who goes to the GP and therefore more likely to need AB.

Pain/severity of symptoms have nothing to do with whether antibiotics have any impact. You can be seriously ill with a virus like RSV (or Covid!) and antibiotics will be pointless, you could have a mild bacterial urine infection that antibiotics would clear swiftly.

Bacterial infections are not more severe than viruses. They are simply treatable with antibiotics, while viruses are not.

@PerditaLaChien absolutely!
Clearly viruses can kill, so the idea of Dr clearly doesn't believe they're really that sick because they not giving us abx, it must only be a virus -just isn't true.

Also just because and infection is bacterial doesn't mean it 'needs' antibiotics. The human immune system is quite capable of eliminating many simple bacterial infections by itself, often so quickly that in trials the difference antibiotics make in recovery/severity is measured in hours not days.

I've only ever had them when I've needed them. But those times were very serious (think severe Cellulitis, septic injury, MRSA, am diabetic with PCOS and related issues (Hidadrenitis Supparativa) causing skin abscesses that can infect v easily) I don't think they give ABs out like Smarties.

Something that isn't being talked about as much though is how the meat we eat (and I say this as a non-veggie/vegan) is often chock full of antibiotics and vaccines. I find that more worrying.

Maybe it depends on where you live in the country.

Two of my kids get very very ill whenever they get ill. They've been admitted to hospital with RSV, COVID and once a really really bad stomach bug. I went with an ear infection that left me deaf on one ear. NEVER have I ever gotten antibiotics for any one of us.

Granted my kids usually have viral infections, which aren't treated with antibiotics anyway. But I'd hoped to get antibiotics for my ear at least. Especially because my ear drum burst. But the doctor couldn't see my eardrum because there was too much blood and liquid, so he couldn't confirm the burst ear drum and wouldn't prescribe antibiotics.
I actually had to go to my GP the next day to get antibiotics. No idea what the a&e doctor thought where the blood and liquid in my ear was coming from it not through a hole in my eardrum from my middle ear 🤦🏻‍♀️

So no, in my local hospital they don't prescribe antibiotics often or easily. Generally the first answer is always "it's viral, plenty of rest and fluids..and give paracetamol and ibuprofen for pain and fevers"

I dont think A&E just give antibiotics for the sake of it

Your child has a chest infection, that requires antibiotics
If they get worse, take them back without hesitation

Bacterial infections are not more severe than viruses. They are simply treatable with antibiotics, while viruses are not.

@PerditaLaChien Yes, my son had a bacterial chest infection and was given a five-day course of antibiotics, it cleared up immediately. He’d been fighting it for about three weeks and definitely needed them.

Of course, he also gave it to me so I ended up on antibiotics too. 😂

@SleepyRich that was exactly my thinking! I didn’t take him to A&E because I wanted antibiotics but because I was worried about his symptoms and I feel like they didn’t pay that much attention to his actual symptoms / what I was saying and instead just gave antibiotics. That said, I’m no medical expert so obviously I’ll give them to him.

What worries me more than pills being handed out following A&E admission is the large and constant use of antibiotics for elderly people. Often taken daily, ramping up until patients are receiving intravenous antibiotics. Studies appear to show a link between gut microbiome and the brain (dementia). I often wonder whether it is only a matter of time before this constant use diminishes the power of our existing antibiotics or whether a new superbacteria will emerge.

If you're unwell enough to end up in a&e you're more likely to need antibiotics than someone who waits and goes to their GP. Having recently benefitted from antibiotics I don't think we should be too hasty to assume they are just given out to everyone. A lot of people hold back going to their GP as they think they won't be given anything and don't need antibiotics but really they could do with them. What needs to happen is patients need to respect when a trained medical professional has said no to antibiotics. As long as they've explained why they aren't appropriate there's no need for people to get aggressive about it.

Interesting discussion in World Antibiotic Awareness Week.

Firstly, don’t feel bad for taking your child to A&E. You were sent there by 111 so there’s nothing to feel bad about regardless of what the diagnosis is.

Whether antibiotics are given or not by any prescriber is more complex than most people imagine. I am one of many people whose job is to help them to make the best decisions. It’s not unreasonable to think that A&E hand out too many antibiotics because the reality is that people still get given antibiotics for self limiting bacterial, or viral infections from A&E and from other healthcare settings. It is unreasonable to think that antibiotics are given to free up space in A&E. I’ve never seen this as a reason for antibiotics being given or ever seen this raised as a concern by the UK networks In part of.

Our children’s A&E is pretty good at getting it right, our adult A&E on the other hand is not. If your A&E is struggling to get it right the hospital should already know that. Changing the prescribing behaviour is hard, particularly if the local community are presenting their with the intention of being given antibiotics when the GP has declined. It makes identifying the patient who really needs treatment harder and means the pressure to prescribe from parents/patients is proportionally higher than the local GPs are seeing.

Not from what I’ve noticed. We have to go to A&E a lot and I’ve never noticed anyone be seen and simply walk away with antibiotics. I have also seen parents who think their child just needs antibiotics but they aren’t given them.

The one time we were there for another reason was when DS had a very high fever for a week straight, and even then they didn’t give us antibiotics, as it was viral.

@Lokielo oh I didn’t realise it was antibiotics awareness week! It’s an interesting area for sure. I have always been very much of the mindset of only taking them if they’re really needed, whereas my sister is at the doctors every other week demanding them for a cold.

I’ve been to A&E a handful of times with kids and never seen antibiotics handed out like that before. It also happened just at handover time, which I guess was why I was wondering if it was to try and move people on.

But like I said absolutely no criticism of the people there, I was more just musing on it.

That said two days into antibiotics and my son has perked right up this evening - will never know if he would have done anyway but rather that than him being sent home without any if he really needed.

This is a great and really well written post.
i would also add that in A&E you are more likely to be seen by a junior doctor who may not have the wealth of experience and confidence in their decision making and prescribing than a consultant level GP will have