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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