Who can actually prescribe antibiotic suppositories?

[Makingmusicinmy50s]

Sorry this a bit long...

This is my first post after years of reading others. I've been searching the internet (and on here) for any similar situations but can't find one single thing!

So, I have a severe case of emetophobia, to the extent that I am tee total, I don't travel on public transport in the evenings in case someone is sick, I avoid walking past pubs, and avoid being around people drinking to excess. I have also not been sick since 1997 (August- I remember it!)

Because of this phobia, I am also unable to swallow most tablets as most make me gag and the fear of being sick consumes me. Liquid medication has the same effect on me. I haven't swallowed medicine/ cough mixture since I was 7. I am now 55 years old.

My issue now is that I have an infected tooth/ gum (it started two weeks before Christmas). It's pretty gruesome and I'll spare the details but it's so grim I am careful not to get too close when talking to anyone in case they can smell it 😳This is the second time I have had this infection. The first time, my dentist prescribed amoxicillan and metronidazole to be taken together. When I got the prescription I realised that while I could swallow the capsules with some difficulty, there was no way I could get the big round white ones down. Anyway, the amoxicillin worked on its own- so all good. This time round, the amoxicillin hasn't touched the edges of the infection.

I found out that the Metronidazole is available in suppository from and the NHS website says 'if you have trouble swallowing tablets your Dr may prescribe these'. The NICE website shows recommended dosage of the suppository. I can't explain how relieved I was to read this so promptly booked a dentist appointment for the next day.

The dentist said they are not able to prescribe this for me as they have no guidelines on this way of taking the medication. They wrote a letter to my GP explaining this and asked them to prescribe it. My GP refused and said it's not available 'in the community; and then said my dentist CAN prescribe it and told me to go back to the dentist. This doesn't make sense to me! I said to the receptionist at the GP surgery that at this rate, I'll end up in hospital on an IV drip and she suggested that this might be a good idea!

I know the tooth needs to come out but it can't until the infection has cleared. Also, I don't have any nerves in that tooth so am not in a massive amount of pain, but obviously some discomfort. It's the swelling and the goo that is getting into my mouth that is most distressing.

I have asked at two local chemists/ pharmacies who say they can order this in and can be in stock in two to three days time, so availability isn't an issue.

I am used to taking suppositories as I have been prescribed Voltarol in this way for over 25 years for when I need pain relief.

Metronidazole can't be crushed up for anyone who suggests that! (not that crushing any pill is an option for me). 'Hiding' a tablet in a banana or yogurt doesn't work for me either :-(

AIBU in thinking that if the NHS website says this is available, then someone should be able to offer it to me?

Can’t you as a pharmacist at one of the community pharmacies you’ve already spoken to to prescribe it for you?

Your dentist needs to prescribe, it’s for a dental issue.

Doctors are not trained nor indemnified to treat dental issues.

I've taken these before for a tooth abscess. I couldn't get a dentist appointment, and my GP wouldn't prescribe for a dental issue.

My work around was just buying them from Superdrug as I filled in an online prescription to say I had BV instead. Not ideal, but it got the job done!

Potentially I'd try going to Superdrug and saying you have BV and would like Metronidazole but only in suppository form. Also it looks like you can get an injection? Could you ring the dentists and ask for that?

My dentist told me that it was outdated that the infection has to be cleared with antibiotics prior to extraction, he just took the tooth out there and then, much to my surprise as I'd had antibiotics before extraction in the past. Said quickest way to get rid of the infection was to remove the tooth.

Your GP is not being unreasonable. It’s a dental issue for the dentist.

If the dentist doesn’t want/won’t/doesn’t know how to or can’t then the dentist needs to refer you to his colleagues at the nearest dental hospital.

Nothing to do with the GP.

Your GP is correct - If it's a dental issue then your dentist should prescribe it.

Also replying to a previous poster - Metronidazole for BG would be vaginally - which won't work for a tooth abscess.

But at the end of the day, it's your emetophobia that's causing the issue - you need to seek treatment for this. There is plenty of treatment available. I have it and am able to take tablets with no problem after CBT/EMDR - I would still go into a frenzy if my kids got norovirus however

Is there oral metronidazole? What if children need to take it? Can you take a syrup?

ive certainly had oral amoxicillin- just had it recently.

Are you happy opening up the capsules and mixing the powder into a bit of yogurt or honey?

I do that for big tablets I can’t swallow.

I also remember the last time I was sick - 1994. My emetophobia is better than it was, thank goodness, so I do now drink alcohol in moderation and will risk public transport. But I want you to know how much I empathize. It’s absolutely rotten, and embarrassing to explain to people.

If you haven’t already done so, talk to a pharmacist about exactly what forms of metronidazole are available - they may be able to find it in a form you can manage, such as a capsule, and which your dentist will be willing to prescribe. They might also be able to recommend an alternative which has similar efficacy for dental infections, and which is available as a capsule. Even if it’s something older, or less commonly prescribed - and even if it’s something slightly less good - an antibiotic you can actually swallow is always going to work better than one you can’t!

My other recommendation is a longer-term one. I had the same problem swallowing pills. Someone suggested practising with sweets. Buy a pack of Smarties and have a go at swallowing one with a drink. Or start smaller (Reese’s Pieces?) and work up to larger sweets. Take it slowly - try once a day, but stop immediately if you get anxious and try again the next day. Don’t move on to a larger size until you can happily swallow something a bit smaller. Get used to how it feels to swallow them. That way, next time you need to take medicine it will just feel like a normal, everyday thing to do. It worked for me. It may not work for you, but consider giving it a go.

I hope you can get the tooth sorted soon!

Try taking it with fizzy juice and throw your head way back. I can't take pills unless fizzy juice.

Is it an NHS dentist? They can only prescribe from a set list of medicines https://bnf.nice.org.uk/dental-practitioners-formulary/ which doesn't include metronidazole suppositories.

The GP isn't supposed to prescribe for dental infections as that's not their area of expertise.

Ask if the dentist can write you a private prescription. Then they could prescribe the suppositories.

The information the dentist needs (if they will do a private prescription) is readily available to them;
https://bnf.nice.org.uk/drugs/metronidazole/#indications-and-dose

https://www.medicines.org.uk/emc/product/9239/smpc#about-medicine

I would get back in touch with them and try to speak directly to the dentist.

This.

i had an infected tooth. Tooth out, job done. No need for antibiotics even as the tooth out meant the infection went with it.

No, it was the tablets that I got from Superdrug, as I said in my post.

Wow, so many interesting replies and useful information. Thank you all.

I did know that usually the GP won't prescribe for a dental issue but with the dentist letter I thought they might make an exception (the dentist thought so too). I will read all of these replies properly when I get back as I've got to pop out for a while now. x

True but often infections can make numbing the tooth up fully difficult. The infection alters the pH of the local area and it stops the anaesthetic working as fully as needed sometimes. If there's active infection I often give antibiotics first then get the patient to return for the extraction.

This is great to know- I will read into this later on today. Really useful. Thank you so much!

Yes, this is exactly what I do already with my daily (tiny) thyroxine tablet. But fizzy water!

I think that is awful of your GP.
I am a GP- and would happily prescribe in these situations.
It's hardly rocket science.. dental infections need metronidazole and it's not as if that drug is not prescribed by GPs for other things, so your GP is being difficult on purpose.
Id book another appointment with a different GP, take the dentist letter along and if they say no , ask why they will prescribe medication if a consultant writes to them requesting a patient has it but not a dentist.
Failing that I'd use an online service such as Boots or Super drug.

Metronidazole suppositories isn't on the dental formulary though.

Is your dentist nhs? A private dentist may be able to prescribe the suppositories. But NHS dentist won't be able to as it's not in the formulary. Local dental hospital may have more range with prescribing.

Just a warning; Metronidazole suppositories are on a rolling order for the pharmacy I work in (when our stock figure reaches a certain level, it triggers an order), and we’ve currently got 6 orders processing from different suppliers (one dated from 2022!), so you might have difficulty actually finding somewhere with the stock.

I also don’t believe that the suppositories are on the formulary for dental prescribers, you might have to ask for a private prescription.

I love this idea to use sweets and will definitely give this a go!

I'm sorry to hear you also have this phobia- it really is rubbish! I can't pin point when it started. My mum says I have always been like this even as a child.

And yes, any antibiotic at this stage is better than none.

Such a lovely kind and helpful reply!
Thank you.

. Also, I don't have any nerves in that tooth so am not in a massive amount of pain, but obviously some discomfort
So in that case maybe this is a situation where the dentist can remove even though infection present?
But I agree, the GP is being unhelpful.

As a previous poster said, for VB, it is a pessary which is prescribed, not a suppository :-( The pessary wouldn't work for a mouth infection.

Interesting about the therapy helping. I always thought I was lost cause and thought that I might be 'exposed' to sick if I tried therapy, so that put me off. Even talking about it makes me feel awful. I'll look into this.

Thank you. This is really interesting. All of this happened on Christmas eve by the way, so the dentist was being helpful, hoping I could get what I need for the holiday period. When I took the dentist letter to the GP, the lady who sits at the pharmacy window in the surgery said categorically that this is never prescribed 'in the community' and that only a patient who had, say, a tracheotomy and was unable to swallow, would be given these. I was confused as the NHS website implied it was readily available. Then the actual GP said no, and told me to go back to the dentist🙁