The antibiotic dilemma

Evidence is rising that taking antibiotics is a bad idea if you don’t really need them. It’s increasingly clear, too, that we are very bad at knowing when we really need them. A worse than average cold, or one that goes on too long, leaves us reaching for a prescription. Doctors bemoan the fact that patients are demanding antibiotics when they have a virus. Not only do antibiotics not treat viruses at all, taking them when you don’t need them can cause antibiotic resistance in bugs you do have.

Studies are showing that taking antibiotics leaves you less responsive to them for at least 12 months – which means that taking them when you don’t need them can lead to them not working when you do.

Last Friday I went to see a GP because I had a persistent sinus infection. I had not seen this particular GP before, but I couldn’t see my regular GP because she was fully booked, and this one was new in the same practice. The first thing she said to me after I described my symptoms was “time for antibiotics, don’t you think?” I was a little taken aback at how fast we had arrived at drugs, and I asked her what made her think it wasn’t a virus. She immediately backed off, saying “It could be a virus, don’t take antibiotics yet – we take too many antibiotics, don’t we?” but nonetheless, I left that office with a script for penicillin, and instructions not to take them yet, but to take them if I needed them.

She gave me no clear guidelines on how to recognise whether I needed them or not. So here I am, it’s Tuesday night. My voice comes and goes, my head feels as though it is going to explode, and my face feels as though it has been ram-packed with concrete. Do I need them now? Is it a viral or bacterial infection? The doctor said not to bother coming back, just fill the script if I needed to. So after much agonising during the day (and a certain amount of agony driving the process), my husband has gone off to get the script filled for me.

Normally I would applaud a doctor leaving decisions in my hands. I don’t let doctors push me around, and prefer to make informed decisions on my own health care. But in this case, the doctor didn’t know me, and had no way of knowing how responsible I would be with that script. I could have gone and got it filled immediately – and indeed it was pretty clear that she intended me to, until I questioned the need for antibiotics up front. Only then did she change her tune and tell me to wait.

Articles in the media bemoaning our use of antibiotics frequently quote GPs complaining that people demand them, but I don’t see that as an excuse for offering them the moment I set foot in their surgery. It is surely an essential part of the GP’s role to educate patients on when antibiotics are appropriate and when they are not. It is crucial both to individuals and society that inappropriate use of antibiotics stops, yet doctors like mine hand them out without any real evidence that they are appropriate, and without even a warning lecture about finishing the entire course if I do start taking them. Not finishing a course of antibiotics is a major cause of antibiotic resistance – yet when was the last time your doctor warned you about it?

I have plenty of friends who leap onto antibiotics the moment they feel a tickle in their throats – and they could not do this without the willing and inexcusable complicity of their doctors, who should know better.

I still don’t know whether taking antibiotics is the right thing to do for me today, but I am going to do it anyway, because I have the script and I feel awful. That decision should not have been left in my hands. Of course, believing as I do that antibiotics are grossly overused, I should not be getting that script filled tonight. I should be making an appointment to see a better doctor tomorrow, and getting better advice. But I have yet to find a doctor who will do much more than wave a script when I present with symptoms like these.

I am tired, sick and miserable. My resistance is low. So I’m going to take the easy way out. Let’s hope my resistance doesn’t become high as a result!

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3 thoughts on “The antibiotic dilemma

  1. Joe

    Ooooh, boy! Hot button! :-P

    This has been an ongoing discussion for at least 20 years. Like the eventually officially deprecated “use paracetamol for babies to reduce risk of febrile convulsions”, medical research percolates only slowly into GP directives, and thence even more slowly into practice as patients expectations have to be met if you want to (wait for it…) … stay in business. And not get sued.

    (I had one GP not only strongly recommend paracetamol when my daughter’s temp was merely 37.5 … he postscripted “and keep some around anyway just to give them when they’re too rowdy, it really calms them down”.)

    Since I’ve been old enough to move house and seek out my own GPs, if I have one that reaches for an antibiotic prescription “just in case” or if they ask me if I want one, I never go back to them. Over the years, I’ve found about one in five or maybe on in ten GPs is actually a good diagnostician who I trust when they say “antibiotics”. And then I’ll pay them whatever they want to let me in the door. There are strong enough signals for stubborn bacterial infections that there should never be a question. (You don’t need antibiotics for most bacteria, either, though in particular sinuses are poorly defended warm moist breeding grounds once something takes hold there.)

    Similarly, gynecologists will press pregnant mothers firmly for induction at due+10 days, because IF there’s placental functional decline it can drop in just a few days and cause problems. But nominal due+10 days is well within normal range, AND monitoring and measurement are available that would indicate the very early stages of placental decline anyway. Countered by the still relatively high rate of unpleasant consequences for inductions. But the poor doctor… if they don’t tow the (out of date) line and subsequently ANYTHING goes wrong, their insurance is void and their whole livelihood is on the block.

    Only a minority of my ailments get me to the doctor. And only a minority of those result in medications. Mostly, millions of years evolution does the job just fine.

    (Besides… I’m a MAAAAAN. Real Men don’t even have ailments. Except Man Flu of course.)

  2. Joe

    ps I loved this line from your opening link…

    “In the past, antibiotic-resistant bugs were mostly seen in hospitals, but they was {sic} now spreading through the community. One particularly virulent strain, …”

    Heh … if it was virulent the antibiotic resistance question is moot anyway :-P

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