Inappropriate Antibiotic Prescribing

Just watched another report on the BBC news about inappropriate antibiotic prescribing. Now there are proposals to punish doctors who prescribe them when they’re not required. Controversial stuff! Where does the blame for this problem actually lie?

As the doctors decide whether or not patients get the drugs in the first place, it would appear that it’s right to target them for misuse of antibiotics. During my years in community pharmacy I’ve received many antibiotic prescriptions for what appeared to be cold symptoms when I questioned patients. One doctor who I called up to query an under dosage of antibiotic for a child said that they didn’t actually think the patient needed it. When I asked what the point of the prescription was if this was the case, they decided to up the dosage.

Some patients can be extremely pushy however. I have heard reports of those refusing to leave without a prescription despite the doctor’s best efforts to convince them that it wasn’t necessary. I remember in particular the account of a friend who sat in with a GP when she was a medical student, and witnessed a perfectly healthy young woman refuse to leave the room until she had received a free NHS flu jab to which she wasn’t entitled. It wasn’t as if the doctor could have her thrown out. Some patients just see other doctors until they get what they want as well.

What’s really needed is better education for the general public as well as prescribers, starting in schools. This is not just in the UK, but worldwide. I’ve had many conversations with people from mainland Europe who have very firm beliefs that you can’t recover from a cold unless you have antibiotics. Antibiotics DON’T work on viruses such as the common cold or influenza. They just can’t be convinced. Some customers have also said to me that they think the antibiotic resistance threat is nonsense. Others didn’t know the difference between a virus and bacterial infection, and why this would affect what treatment you could get.

The thing that drives me the craziest is the fact that you can buy antibiotics without a prescription in some countries, such as Spain. One Spanish customer proudly told me that she stockpiles them with encouragement from her “pharmacist” brother, and takes them whenever a cold starts. She would then not finish a course, but stop whenever she felt better. “Why is it that when I take antibiotics I always feel better?” she scoffed at me when I expressed my disapproval of this flagrant antibiotic misuse. Maybe because you would’ve felt better anyway, without the drugs?? I’m enraged just recalling it.

Antibiotics are also overused in farming to prevent diseases in livestock, introducing yet more microbes to substances that they can build up defenses against. Those who should really know better have also demonstrated that they don’t: recently there was a news article about a pharmaceutical factory in China dumping vast quantities of antibiotics into a river, and it appears that this practice occurs more often than we realise worldwide.

What some just don’t understand is that the biggest threat to all of mankind is antibiotic resistance. There are many microbes now which can’t be killed by antibiotics which previously wiped out infections with ease. Methicillin-(or multiple-)resistant staphylococcus aureus (MRSA) is one famous example. Development of new antibiotics is a long and arduous process. If no antibiotics work, we’ll be plunged back into an age where a simple cut or graze could kill. We have to accept that the responsibility for ensuring that antibiotics are still effective does not just lie with doctors. The blame cannot be apportioned just to pharmaceutical companies with questionable waste disposal techniques, or farmers, or pharmacists, or patients. We are all responsible. The sooner the world can wake up to this fact, the longer we can keep antibiotic resistance at bay.

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