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?

I'm not emetephobic thankfully, but I do have a hair-trigger gag reaction which makes taking pills unpleasant at best and impossible at worst, so you have my every sympathy, OP.

Some of my happiest times of being ill have been spent in France, where medication by suppository is the norm, rather than the exception. Once you get over the slight weirdness of it, it is so much easier and more effective.

As PPs have suggested, have you tried contacting your local dental hospital, which presumably will have an attached pharmacist?

Exactly this!!

😩

And yes, I am going to contact the nearest dental hospital and see what help they can offer.

Are you really a GP?

If so you need to speak to your indemnity provider urgently if you’ve been treating dental issues as a gp.

Subsequently you need to review every prescription you’ve written on the say so of a consultant - you are legally responsible for the safety of that script, whether another doctor suggested it or not.

A major educational need for your next appriasal.

From your post it's quite clear that you are not a GP, you've written complete nonsense. A dentist requesting a GP prescription is not the same as a hospital consultant. At the end of the day it's the GP's signature on that prescription and if they get sued, they are not covered for dentistry. If you are really a GP, you're on dodgy ground with your practice.

OP - your dentist can prescribe Metronidazole liquid on their formulary, that's much more common than suppositories so I'm not sure why they didn't.

@Makingmusicinmy50s why don't you just take the liquid?

Given the budgets within the NHS, I can see the dentist being cautious about prescribing the liquid. Tablets are approx £4 for a packet of 21, while 100ml of liquid is approx £32 and to achieve the correct dose you'd need 2 bottles. That's a difference of £60! You'd get it far more easily asking for a private script. Given you can manage your thyroxine, your best short term option is to discuss alternatives with your dentist and long term to use a pp's advice and train yourself to manage tablets.

I am definitely a GP and work in medical regulation, so not talking rubbish.
Firstly the GP would indeed be held responsible for the script they sign, however they are not being asked to prescribe anything particularly unusual or out side their scope of practice. Metronidazole is a drug with a license for use in dental as well as other infections. The OP merely wants it in an alternative form.
If she was asking the GP to prescribe say hormone blockers or medication that is restricted to secondary care use only I would be saying something very different.
As far as saying we shouldn't consider requests from dentists, for something as simple as prescribing a commonly used antibiotic in a form the PT can comply with ..well I think that under GMP ,working with colleagues, that is covered. I suggest you go back and read it.
The MDU and BMA advise that while GPs shouldn't provide dental treatment, they should provide antibiotics for infections where a dentist is unable to, such as in an emergency situation.
The GMC also sets the standards ( note since publication of latest version, it is referred to as standards not guidance) at the very beginning by stating " you must make the care of your patients your first concern".
I'd say changing a prescription from tablets to suppositories for a patient with an infection is putting the care of that patient front and centre, instead of squabbling that it's not your job
Id not be offering " dental treatment" I'm not competent to do, I'd be treating an infection, which I'm more than competent to do.
I'm not breaching GMP in anyway, after all I'm and autonomous prescriber and am entitled to prescribe what I want as long as following GMP and associated standards on prescribing.

As I mentioned in my OP, I have the same (if not worse) reaction to liquids.

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

I also have bad emetophobia and cannot swallow tablets. But I had metronidazole recently for a gum infection and used a pill cutter to cut it into quarters which I could manage.

I also called the GP to prescribe some antisickness tablets in case the antibiotics caused sickness.

My GP has prescribed abx and pain relief for a dental infection in the past where there was a delay before I could get dental treatment. There didn't seem to be anything controversial about it, he did it without hesitation. So I think it must be a matter of the clinician's discretion. I was in his clinic for something else before anyone has a go about wasting a GP's time with dental problems.

As a fellow emetophobe I’m amazed you’re willing to take Metronidazole. I had a tooth infection but was too afraid to take antibiotics so let’s just say I “treated” it myself

Where are you seeing the MDU and BMA saying that GPs should prescribe antibiotics??

BMA: https://www.bma.org.uk/advice-and-support/gp-practices/gp-service-provision/patients-presenting-with-dental-problems

MDU: https://www.themdu.com/guidance-and-advice/guides/treating-patients-with-dental-problems

Thank you for being a reasonable GP. It’s hardly unusual for a GP to prescribe metronidazole from what I can see.

All these guidelines and box ticking exercises can cause extra pain and a real sense of horror and depression at times when all you want is just reasonable advice and timely help.

All this shrieking and finger pointing is not in the spirit of ‘do no harm’. Delaying medicine can cause more harm and when it’s a regular prescription I can’t see the justification for holding back.

It’s like “the computer says no”.

Just be reasonable like this GP!

@PlopSofa Well said!

'All these guidelines and box ticking exercises can cause extra pain and a real sense of horror and depression at times when all you want is just reasonable advice and timely help'.

This sums up exactly how I have felt since Christmas eve. 🙁

@Makingmusicinmy50s oh you have my sympathy ❤️‍🩹 you poor thing. That’s awful it’s gone on so long. Are you eating?

I had a wisdom tooth out just before Christmas, had to go back three times and ended with antibiotics on 22 December. I was terrified I’d be in pain with the surgery shut over Christmas.

It was metronidazole also but I didn’t take it as it makes me feel nauseous. I had some amoxicillin in the cupboard at home from a trip to France where a lovely doctor thoroughly overdosed me for a toenail infection at a very high dose for 2 weeks. I took that instead as I still had a week left. Could your dentist prescribe this instead? Would it be easier to get hold of instead of metronidazole suppositories?

I know some bacteria are resistant to amox now but it worked for me and it always worked for my mum too for tooth/gum/sockets.

@PlopSofa

'I had a wisdom tooth out just before Christmas, had to go back three times and ended with antibiotics on 22 December. I was terrified I’d be in pain with the surgery shut over Christmas'.

Ouch! I feel your pain 😰

Yes, I'm eating, the pain isn't too bad as I had root canal on that tooth many years ago so have no nerves there, just a mild pain, say 3 out of 10. But it IS uncomfortable, I'm visibly swollen and have 'leakage' from it into my mouth 😩The last time I had this swelling, my dentist said if I had nerves there, I'd be rolling around in pain. Small mercies I suppose.

I took amox 2 weeks before Christmas with high hopes as it worked perfectly before, but not a jot of difference this time. Maybe I'll just try another course. I have a method of swallowing these but it's still a performance three times a day!

I've got a scheduled app with my dentist in 2 weeks time but will take another course of amox in the meantime. Then I will ask about him if he can write me a private prescription for metronidazole.

I'm always proactive in my own healthcare, but have hit a brick wall with this :-/

Could you call the surgery tomorrow morning and ask for the private prescription of metronidazole. No reason why they can't prescribe over the phone and you pick it up tomorrow morning.

I don't think more amox will work unfortunately.

Also, OP, you could try salt water bathing, so warm water with a bit of salt in. Hold it over the bad tooth for a few minutes, rinse and repeat.

Also chlohexadine is good. I have a spray, I sprayed that regularly on my wisdom tooth socket. Lots of relief. It kills everything it seems.

Also consider getting a clove and just sticking in and around that area. Things will go numb. It's a great anti-bacterial and anti-pain thing.

I'm sorry you're in this situation.

I can't think of how else to help. Long term I wonder if maybe deliberately making yourself wretch might help give you some exposure to what being sick is like and seeing that actually, to wretch, it's not that bad. No it doesn't feel great but it's OK. You feel a bit horrible for a few seconds. Then it's gone. A bit like being sick. It doesn't last. It's not for long. To me it seems like the fear is far greater than what actually happens. It's just a like a shudder. Then it's finished. Body still intact. Nothing fell off. No mortal wounds :)

When you are sick, it's a normal response from the body. It just gets on with it.

And it's gone very soon. I had norovirus few days after my wisdom tooth extraction. It's been quite a Christmas frankly!

Anyway, it was not pleasant but I'm still here. Definitely CBT may start to break it down for you and maybe some EMDR. Hypnotherapy also. It would be great if you could start to worry less about it. It sounds like it's a very big thing for you and makes your life quite hard at times. I hope you can find relief all round.

@PlopSofa I'm going to do everything you just suggested, including calling the dentist tomorrow. I will report back here with the outcome of whether or not I get a private prescription :-)

Good luck! 🤞

Dentist here!
Im really surprised your GP hasn’t helped you out with an equivalent dose of Metronidazole. If one course of Amoxicillin before Xmas hasn’t helped, there’s no point you taking any more, you’re just risking side effects for no benefit.
Try another GP at the same practice?? Or ask your dentist to call your GP directly….?

How did it go OP?

NEVER throw your head back.

That opens up the airway and massively constricts the gullet.

That is why you tip heads back to do CPR !