GPs should consider delaying prescription of antibiotics, says NICE
BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4486 (Published 18 August 2015) Cite this as: BMJ 2015;351:h4486
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The world witnessed a conceptual global evolution in 1928 with the birth of penicillin by Sir Alexander Fleming that heralded the dawn of the antibiotic age. Antibiotics are magic pills that have saved millions of lives but antibiotic resistance is slowly losing its charm. Emerging mutated pathogens, the so called “superbugs”, and antibiotic resistance have fueled the search for new antibiotics to cope up with life threatening mixed infections but it still remains in its infancy stage.
Across the globe the need to elicit a detailed case history by talking to your patients, careful clinical examination, judicious use of diagnostic aids, and use of antibiotics only when indicated should be stressed upon to prevent antibiotics from masquerading for mankind.
Drug resistant microbes remain a thorny therapeutic issue for physicians who are unable to figure out the solution for the same and continue to prescribe antibiotics due to fear of feeble clinical practice, medico legal issues, patient pressure and for a short term quick solution.
The goal of infectious disease therapy is to get rid of the host of the pathogen, but more often we are more focused on the pathogen and we continue to bombard the host with a myriad of these “magical bullets”. The last decade has witnessed a plethora of antibiotic resistant bacteria not just MRSA but many other insidious bad bugs, and to tackle this, the pipeline of new antibiotic is slowly emerging as empty.
The misconception among the public is that they can self-medicate (Pill popping syndrome) and be erratic and not complete a course of antibiotics according to their whims and fancies; this is a societal menace of tremendous magnitude that needs to be eradicated at its root level.
Futuristic approaches like Engineered drugs based on bacterial genetics, antibiotic hybrids, apps on our smart phone that can differentiate which form of microbial life we have become infected by may all look gloomy at present but will definitely materialize if absolute cooperation is rendered from all sections of the health industry.
Lastly there are many hurdles in the path to victory against these talented superbugs and we hope that the war against them soon comes to an end by using our resources judiciously, warning physicians and the public of catapult effects that can occur with the widespread use, abuse and misuse of antibiotics.
Competing interests: No competing interests
Re: GPs should consider delaying prescription of antibiotics, says NICE
The reasons for the frequent and unnecessary use of antibiotics for "chest infections" in primary care are two-fold.
First, the widespread ignorance of the fact that upper respiratory tract viral infections result in lower respiratory tract inflammation. Approximately 30% of indivuals will, over a lifetime, usually suffer airway symptoms in response to an upper respiratory tract infection. The famous person in whom this happened repeatedly was Winston Churchill, as described by his physician, Lord Moran in his biography of his patient.
The airway symptoms concerned are one or more of the following. Chest tightness, chest pain, cough, sputum which may be purulent, wheeze and shortness of breath. These symptoms can be distressing and can last for a week or two but may persist for much longer.
The frequent and unnecessary use of antibiotics results from the failure to treat these symptoms quickly and effectively in a patient who has also been told he has a "chest infection".
The term 'Chest infection" is misleading in this context as indeed inmost others.
'Viral induced bronchitis' is more accurate and that diagnosis would not cause a demand from the patient for an antibiotic!
The second reason for the misuse of antibiotics is the widespread ignorance of the fact that anti-asthma treatment, even topical steroids in adequate doses, will speed up the treatment of these symptoms.
I would be very surprised if this understanding and approach were achieved in primary care, the reduction in antibiotic prescribing in "chest infections" wasn't many times more than the 4.2% reduction achieved by Butler in a rather complicated and expensive controlled trial that he conducted some years ago in primary care practices in South Wales.
Incidentally did the results from this trial prompt the current NICE advice?
Competing interests: No competing interests