ANTIBIOTICS

It is our policy to prescribe antibiotics appropriately. Often we are asked to prescribe antibiotics for viral infections such as sore throats and simple coughs and we have to say "no". We understand why many people feel that a short course of an antibiotic might clear up an infection more quickly - perhaps because one has helped previously - but for most simple infections in normally healthy people they are most unlikely to make a difference (see Bugs). Because there are serious disadvantages in using antibiotics unnecessarily we believe it is our responsibility to control their use:

• Side-effects: This is the most important reason for you, the patient. Antibiotics are rarely specific to one type of bacteria. Also we all have "friendly" bacteria in the gut and other parts of the body which do useful jobs for us such as helping digest our food and preventing certain infections such as "thrush". These are often killed by antibiotics unintentionly with the consequence that we frequently suffer from diarrhoea and "thrush" as a result. This is a price worth paying to get rid of a serious illness but if the antibiotic wasn't really needed in the first place then it certainly is not. Also, this "collateral damage", in military language, can itself be very serious.
• Allergic reactions: These can range from rashes to collapse and breathing problems. They are rare but can be unpredictable so it isn't worth running the risk unnecessarily.
• "Superbugs": Every time we use an antibiotic we run the risk of producing a bacteria which is immune to that antibiotic. This can then be passed to someone else so giving them a "resistant" infection. Even worse, some types of antibiotic resistance can be passed from one bug to another and so may even be carried by our own gut bacteria ready to be passed to harmful bacteria that might infect us in the future. Bacteria are now emerging which are resistant to almost every drug we have. Although they aren't any more powerful than ordinary bacteria they are a major problem to treat. In the past we assumed that the drug companies would always keep ahead of the game by creating new drugs - now we realise that this is too optimistic and it is up to everyone, doctors , patients and everyone else that uses antibiotics such as farmers to restrict antibiotic use to when they are really needed.
• Cost: I've put this last because really it is the least important consideration by far, especially since many of the commonest antibiotics such as penicillin are very cheap but obviously even the odd pound spent unnecessarily is a waste of resources and if multiplied up throughout the NHS can contribute to problems paying for other services. Rest assured that we would not withold a course of antibiotics needed to treat an infection because of the cost alone.

WHAT CAN THE PATIENT DO?

• Be patient: Not all viral infections clear up in a couple of days. If you are normally healthy and you feel quite well in yourself a "cold" or sore throat or dry cough is not going to need any specific treatment and you can safely wait for them to be cured by your own immune system. After a week you may want us to check that further treatment isn't necessary but be prepared to be reassured and told to continue with simple remedies.
• Try to understand why an antibiotic isn't being given to you - especially if you or someone you know was given one for what seems like the same condition. Remember the doctor is trying to save you from unnecessary unpleasant and possibly dangerous side-effects and also preserve the usefulness of the drugs for the future. It might be you that really needs the drug next time round.
• Don't ask for an antibiotic: The doctor will always consider if an antibiotic will help and prescribe one when it's necessary. By all means ask the doctor what is wrong and how it can be treated but trust the doctor's judgement if an antibiotic is not offered. Most of all NEVER INSIST on an antibiotic.

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