Antibiotics are such a fragile resource why do we continue to abuse them?

It’s now OK, according to a paper in BMJ not to finish a course of antibiotics.  It is merely a myth according to researchers who can find no evidence that stopping your antibiotics when you feel well, does not lead to bug-resistance as we have always believed.   Doctors, however, in spite of this finding are still suggesting that you should continue to take antibiotics as instructed and that means completing the course.  It’s all a bit confusing and what’s the fuss anyway?

For antibiotics the problem is that misuse affects the health of others by creating resistance and we have been struggling with this problem for about 30 years.   Along with cigarette smoking and obesity, antibiotic resistance represents one of our biggest public health challenges.  Seriously it is a problem that is that big.  If we fail to do anything, according to the Chief Medical Officer for England Dame Sally Davis and other equally eminent medical scientists, the consequences will be dire.  Infectious diseases common a generation ago will return with a lethal vengeance, routine operations such as hip replacements will simply not take place as the risk of severe infection will be too great.  The closure of hospital wards such as the one in Altnagalvin over the last few days is a direct result of our overuse.

Every pharmacist, doctor, nurse, in fact anyone with a GCSE in biology, appreciates that bacteria are smart and nature endows them with a certain genius to get around any medical hardware we care to create.

We need to use what antibiotics we have with much greater care; few new bug-busting drugs are in the pipeline and resistant bugs are emerging at an alarming rate.  That is the message from the recent UK National Institute for Clinical and Healthcare Excellent (NICE) report on Antibiotic Stewardship and it merely echoes what has been said since the 1960s; the only difference now is the crisis really matters clinically.  Leaflets and campaigns are not doing much to change public and patient behaviour.  Such is the mythic power of the antimicrobial, changing patient behaviour seems almost impossible but perhaps we are failing to focus on how real change might be brought about.

GPs too easily give in to patient pester-power and community pharmacists have a perverse incentive to dispense what is prescribed rather than challenge lazy prescribing.  If the NICE recommendations on antibiotics are to bring about real change they need to better appreciate patient behaviour and the real world they live in.  Creating confusion on whether you should complete a course or not must not detract from the fact that for most common infections we should not be using antibiotics at all.

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  • Laurence Rocke

    W have to be very careful about this. It would be madness to act on the basis of a single uncorroborated research paper without a lot more evidence. In addition, it is crazy to present this to the public in such a cavalier way. People are already often tempted to stop taking antibiotics just as soon as they begin to feel better, while they may still have an active infection. It is very important to stick to current guidelines and instructions until there is more evidence.
    Much better to continue to work at trying to educate the public not to demand drugs for viral or inconsequential infections and make sure GPs do not prescribe unnecessarily or use inappropriate antibiotics.
    In addition, there should be even more pressure on the agriculture sector to completely stop the blanket use of antibiotics for no good reason.

  • Reader

    Laurence Rocke: People are already often tempted to stop taking antibiotics just as soon as they begin to feel better…
    Because they want to get back on the booze?

  • The worm!

    To me this one is a bit like global warming. Namely, we are too often rhymed off the consequences SHOULD it happen, rather than being given real evidence that it is happening backed up by proof, or at least sound reasoning, that our actions are causing it.

    I look forward to your pieces, they are generally knowledgeable, well informed, and very interesting. But in this case I’m afraid it contains more of the former when I’d really like to see more of the later (should it exist).

    I do agree entirely with your charge of “lazy prescribing” however, but I feel it needs to be addressed within the medical profession rather than either hoping or expecting that the population suddenly start acting responsibly.

    Oh, as it happens, I can’t even remember the last time I took a course of antibiotics!

  • notimetoshine

    You make a good point about confusing the public which is at the core of the issues that health ‘journalism’ has.

    The poor quality press (daily mail, mirror, sun etc) jump on one research paper take it wildly out of any scientific context and publish it as fact. The public being gullible and with no sense of the nuance and methods of scientific research, then take this reporting at face value. These papers seem to trawl science journals for anything that they can repackage as clickbait nonsense.

  • Am Ghobsmacht

    We need to bring back that old animated advert about the man fishing for prescriptions.

  • William Kinmont

    Good points except the last one. Agri certainly does not use antibiotics for no good reason due to the simple fact that they have to pay for them . Animal licensed antibiotics can be 5 or 10 times the cost of the exact same human product due to the economies of scale as human use is so much greater. The bulk use of antibiotics comes mainly in more intensive agriculture which we can’t do without if we want the supermarket shelves to remain stocked. Agri is doing practice things in terms of husbandry and vaccination to reduce use.
    I am not sure how much of the human use resistance is due to gp and pharmacy prescribing and how much is due to ever larger hospitals with ever larger throughput.