Antibiotics - what's wrong with 'just in case'?

Antibiotics are not as harmless as they were once thought. Many patients are allergic to penicillin and some to other antibiotics.
Winter is well and truly on its way - the nights are getting darker, the days are getting colder, the trees are bare of leaves. But the clearest sign to every GP of the winter season is the sudden surge in patients attending with coughs and colds.

When I was a girl (admittedly a very long time ago) doctors would regularly give out antibiotics 'just in case'. We knew that most coughs, colds, earaches and sinus pains were caused by viral infections, but we would give antibiotics on the assumption that they wouldn't do any harm and now and again they might help. Now we know very differently.

Why do so many patients still want antibiotics? Many of my older patients are convinced that antibiotics 'cured' their colds in years gone by. They got a nasty cold, they came to the doctor, they got a prescription and within a few days their symptoms had settled. Case proved? No. The trouble is, antibiotics were taking the credit for the wonders of the immune system. The vast majority of coughs and colds are self-limiting - within a few days of getting most infections, the body's immune system rises to the challenge and fights it off. But patients' perception is that they get better within a couple of days of taking antibiotics. It's hard to make them understand that they would have got better anyway.

We now have a wealth of 'double-blind, placebo-controlled trials' to prove it. In this sort of trial, patients are divided into two groups. Half are given the real thing - the antibiotic - and half get a placebo, or inactive 'sugar tablet' which looks the same. The key is that neither the patient nor the doctor knows which one they're getting. That means mind over matter - believing you're getting better because of the antibiotic - is ruled out. These trials show that for most coughs, colds, sore throats, sinus infections and earaches, antibiotics don't make the slightest difference to recovery time or the risk of getting more severe complications.

What's more, antibiotics are not as harmless as they were once thought. Many patients are allergic to penicillin and some to other antibiotics as well. You can become allergic to an antibiotic after having had it without any problems several times. The first time you show signs of an allergy, you may get a simple itchy rash. The next time after that, your body is primed to fight off the antibiotic 'invader' and the result could be fatal. They can cause diarrhoea and other side effects. Looking at the bigger picture, antibiotic resistance is becoming a bigger and bigger problem - we read about the 'superbugs' we don't have any effective treatments for, but there are lots of other germs which are resistant to some but not all. That makes it harder to know which antibiotic to give if you do need them.

The Health Protection Agency reminds us that a major driver for antibiotic resistance is using antibiotics when they're not needed, although taking your course correctly if you are prescribed them is also important. This week there's a Europe-wide initiative to reduce inappropriate prescribing of antibiotics. Your GP may therefore give you a leaflet to explain why he or she hasn't given you a prescription, and which symptoms to look out for. If you do get any of these 'warning symptoms', you should definitely go back. But in the meantime, don't give your doctor a hard time if you don't get a prescription - they're not trying to save money, just practising good medicine!

Dr Sarah is unable to provide medical advice or respond directly to questions concerning your health. If you have health concerns we recommend contacting your GP.