Less is more - save our antibiotics!

23rd November 2011

Antibiotics are a precious resource that we risk losing within a generation if we do not safeguard their use.

This is the message from Black Isle GP Dr Gail Haddock, who is calling for much better use of antibiotics as part European Antibiotic Awareness Day.

Dr Haddock, who is a member of the Scottish Antimicrobial Prescribing Group and NHS Highland Antimicrobial Management Team, explained that, in many cases, antibiotics are prescribed when they will have absolutely no benefit and may cause harm to the patient.

She said: "Antibiotics are appropriate for specific conditions, such as urinary tract infections, skin infections and some fevers that are not caused by the flu. For serious infections, such as meningitis or pneumonia, antibiotics can be life saving. Most antibiotics are anti-bacterials, which are drugs that kill bacteria, but have no effect on viruses.

"Antibiotics will not help someone with the common cold, flu or most sore throats to recover more quickly. And, even when bacteria are involved, antibiotics only shorten the duration of symptoms of a sore throat by eight hours compared to taking simple painkillers.

"The more we prescribe antibiotics the more likely it is that resistance will develop. Whereas, the less we use them when they are not necessary, the more effective they will be when they do need to be prescribed."

Dr Haddock added that some patients believe antibiotics are a cure for all ills and are quite insistent that they get a prescription when they should really be challenging their GPs and asking why they are being prescribed antibiotics.

She explained that in some situations, antibiotics give very little benefit - or no benefit at all - and may cause unpleasant side-effects. Some examples are:

• If we give antibiotics to 100 children suffering with an ear infection, 83 would have got better anyway, 17 might have their earache symptoms reduced by a day, but six of the children will suffer from vomiting, diarrhoea or a rash.

• On average, ear infections last for four days, sore throats, tonsillitis and colds last for a week and sinus infections will last over two weeks. These timescales are the same with or without antibiotic treatment.

• To prevent one case of a severe complication of sore throat, such as 'mastoiditis' or 'quinsy', we need to give antibiotics to around 5,000 people.

If children have a rash, a sore or stiff neck, or are not drinking fluids or passing urine, then advice should be sought from their local GP practice or NHS 24. The doctor or nurse practitioner can then assess the need for treatment, which may or may not include an antibiotic.

Otherwise, anyone wanting to alleviate the symptoms of a common cold, flu or a sore throat should seek the advice of their local pharmacist.

Alness Community Pharmacist, James Higgins, said: "High street pharmacists are a good source of information and advice for the public about common infections. They will be able to explain how best to relieve symptoms and help decide on the best course of action."

• High Street pharmacists can give advice and treatment on most self-limiting conditions and can now prescribe certain medications to their registered patients on the minor ailment scheme.

• NHS 24 is available for advice night and day on 08454 24 24 24. See www.nhs24.com for useful self help information.

• Another useful website for information on a wide range of conditions is www.patient.co.uk.

• Antibiotics have been used with great success to treat infections for over 60 years. However, widespread use has resulted in multi-resistant organisms, such as Methicillin-resistant Staphylococcus aureus (MRSA).

• When antibiotics alter the natural bacteria in the gut, more resistant organisms, such as Clostridium difficile (C. diff), can overgrow and cause diarrhoea.

• Doctors are constantly improving their prescribing to match new evidence and C. diff rates have dropped by 71% across Scotland since 2007, with Highland's results amongst the best. But, with hardly any new antibiotics under development and those that are will not be ready for years, it is important to keep improving the way in which they are prescribed.

• The Scottish Antimicrobial Prescribing Group (SAPG) is a national group set up to improve antibiotic use across Scotland. It aims to make the best use of antimicrobial drugs to treat infections and minimise harm to patients and the wider society. See www.scottishmedicines.org.uk