Why do doctors never take test to check if it is viral or bacterial

[misscph1973]

My DD has been prescribed antibiotics 4 times since Christmas. The only time where a test was taken was last time, where it was a suspected urine infection. The test result took 5 days but the antibiotics were still prescribed. The test came back negative.

I am not best pleased that DD has been given so many courses of antibiotics in such a short time. I am of the opinion that antibiotics kill everything and thus eases the way for new infections and also I am worried about DD developing resistance to antibiotics.

My question is: Why do doctors never/rarely take any tests to decide if an infection is viral or bacterial? I am from Denmark where it is unheard of to give antibiotics without a positive test result. It is often a simple blood test taken from a drop of blood from a finger and result is available in a few minutes. It can also be a urine sample or a more complicated test but most often the test doesn't even need to be sent to a lab.

Why do the NHS not have a similar system? It's not like Denmark is a country that is considered more advanced than England.

Cost probably the main reason.

Most things will be viral so it is often best to just sit and wait and then unless they are showing signs that something is bacterial or it isn't clearing then they generally won't give antibiotics.

You are probably right, Sirzy. There is just always some scare in the news about antibiotics resistance, you would think tests were worth it.

Thanks, literarygeek. My GP has never suggested a swab or a sputum.

I am quite happy with my GP, and I had thought that perhaps he thinks I have come to get antibiotics ;)

I had already decided that next time he suggests antibiotics, I will ask if it is reasonable to wait and see before I give it. I don't normally go to the GP unless I am worried, but on all 4 occasions the illness started either right before a weekend or a bank holiday, and I do prefer to see my GP instead of waiting in the A&E.

I have, with the agreement of my doctor, taken a prescription for antibiotics for one of my children with a suspected infection, and held onto the script for a few days to see if we need to fill it. This is especially useful for over a BH weekend. If the child worsens, then I'll fill the prescription and give them the medication. If they get better without it, I shred the script and that's the end of it. Might this be worth exploring with your GP?

Thanks, Poledra, I have also done this on a few occasions with my dd and also my ds, so that is definitely a possibility next time. Hopefully with the warmer weather the next time will be a long time from now!

This is my first post. I am a final year medical student in London.

You describe an easy finger prick blood test? This does not exist, not here at least. If a bacterial infection has progressed to the blood stream then the patient is septicaemic. The patient is acutely unwell and cultures would be taken. Even then it takes at least 24 hrs for cultures to return depending on the organism.

Urine samples do not even test for bacteria, they test for changes in urine such as protein, blood and nitrites which can be associated with but not specific for a UTI.

Medicine, I can only speak for England, is mostly empiric. If it looks, walks and sounds like a horse, we assume it's a horse.

Thanks, AwkwardPingu, nice to hear from a professional ;) although it is rather depressing to hear that medicine is not an exact science...

In the US, children are routinely seen by paediatricians, who do a strep test (throat swab) for sore throats before prescribing. The results don't anything like 5 days.

Yes but in America your medicine is private and its all charged back to your insurer at a phenomenal cost. They are also practising very defensively so do things to avoid getting sued rather than what is best for the patient. Here we use other measures like Centor criteria which is an evidence based way of working out who needs antibiotics - without fancy invasive tests for the sake of it!