Are we prescribing too any antibiotics? Yes, but the reasons to prescribe have often very little to do with the illness.

I read an article today.

http://www.dailymail.co.uk/news/article-2957851/GPs-bonus-doing-job-Doctors-rewarded-cutting-antibiotics-bosses-fear-losing-power-fight-infections.html

It was another reminder of a topic that has been discussed a lot lately- antibiotic prescribing.GP’s are again blamed for something which might have nothing to do with them- bacterial resistance to antibiotics.

Are we prescribing too many antibiotics to people that don’t need them? Probably.

My waiting room this time of the year is full of patients with sore throat, ear infections, and cough.Yes, most of these infections are viral and self-limiting. But every day, I am put under pressure by patients who want me to “do something”.

My assertion that the doctor who will discover a cure for common cold will get Nobel Prize for medicine and that it is not going to be me makes patients chuckle, but not necessarily stop demanding antibiotic.

There is of course no way knowing for sure if an infection is bacterial or viral. Antibiotics kill bacteria, not viruses. So I listen to the patient, examine them, and decide action.

My decision to prescribe an antibiotic might be influenced by underlying chronic medical problems- diabetes, asthma, other chronic illnesses, where my threshold for prescribing is lower.Of course, it does not REALLY make sense- a viral infection does not get better with antibiotics even if the patient is a diabetic. The theory behind prescribing antibiotics for these groups of people is to prevent supra-infection by bacteria later. Is that really a valid reason? Who knows?

I remember various research showing that doctors are more likely to prescribe antibiotics to patients that are of the same socio-economic class “people like us”, or patients who are demanding.

There was also a fascinating American article stating that more doctors prescribe antibiotics in the afternoon when they are tired.

http://www.telegraph.co.uk/news/health/news/11144631/Doctors-more-likely-to-wrongly-prescribe-antibiotics-in-the-afternoon.html

Then there is the “I am going on holiday next week and I need to be well” patient. Or actors before première, students before exams…

I understand. Writing a script is the fastest way to get the patient out of the room. Cynical? Maybe.

But you know what? I do try. I print leaflets for parents of children with ear infections “ Why was I not prescribed an antibiotic.” I tell patients that most sore throats are viral, and no, they do not have tonsillitis, I tell them their chest is clear and “ it is just a cold”.

 But sometimes, I pick my battles. You can’t win them all.

The half way trick is a so called “delayed prescription” “I don’t think your child needs antibiotic, but it is Friday, I will give you a script, but only take it to the pharmacist if the patient develops: ……” and I tell them the symptoms.

Research showed that fewer than 40% of patients used the script for antibiotic eventually.

http://www.bmj.com/content/348/bmj.g1606

But do you want my real reason for doing it?

It is a win win situation- the consultation is non-confrontational, the patient leaves happily and I can see the next one.

But of course, some of these patients will use the script when they did not need to. And antibiotic resistance will go up.

Yes, I know…but don’t you “pick your battles” in your workplace?

Advertisements

2 thoughts on “Are we prescribing too any antibiotics? Yes, but the reasons to prescribe have often very little to do with the illness.

  1. Funnily enough I have a complaint by a patient with a mouth ulcer who wanted antibiotics thinking it was tonsillitis. She was not happy. She saw 2other doctors in the surgery after that who fortunately did not give her antibiotics either!

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s