By the way ... How to stop GPs over prescribing antibiotics

PRIOR to the discovery of effective medicines for killing bacteria, death from seemingly minor infections — such as tonsillitis or ear infections — was not only possible, but common. The breakthrough came in 1940 with penicillin, and other effective antibiotics followed. But there have been no new antibiotics since 1987 and, as we all know too well, the golden era is now coming to an end with the emergence of bacteria that are increasingly resistant to commonly used antibiotics. One factor in antibiotic resistance is overuse by doctors. We have been urged not to give antibiotics for minor illness since 1998, yet research confirms they are still being prescribed for up to 80 per cent of coughs, sore throats and upper respiratory tract infections — most of these are viral in origin and therefore not controlled by antibiotics. But, crucially, some are caused by aggressive and potentially lethal bacteria such as streptococci, which may cause anything from tonsillitis to pneumonia, serious skin infections or conditions such as rheumatic fever. Another type, haemophilus influenzae bacteria, can cause ear, sinus and chest infections, but also lead to meningitis. Faced with an ill patient with a high temperature and obvious tonsillitis, how can a doctor distinguish between a bacterial and a viral cause? And, for that matter, when faced with a patient with symptoms of cystitis and a history of previous kidney infections — which are always bacterial — how can a GP decide which antibiotic is correct? The answer is to send a sample to the lab: simple science will either exclude bacteria or identify the bacteria involved. And if bacteria are identified, then we can choose the antibiotic proven to work against that organism. With this technology at our disposal, why are we not doing the relevant tests? All my colleagues stumble when I ask them, citing concerns over the costs, the fact that a report will take at least 48 hours to arrive (sometimes this is too long to wait, so antibiotics are prescribed in the interim) and that a further consultation will be required to advise on prescription. But my question is: are we practising medical care that cuts corners or offering a service of excellence as we have trained to do? Look at the cost of compromise in the longer term — antibiotic resistance, the end of a golden era, the era of treatments that actually worked.