Why all of us have to learn to take no for an answer where antibiotics are concerned
The only thing that surprises me about this week's Panorama programme, the 'Antibiotic Apocalypse', is that it took the programme so long to decide to investigate it. Last month saw the release of a government document anticipating an outbreak of antibiotic-resistant blood infection, which could affect 200,000 people and kill 80,000 of them. They warned that procedures we take for granted, like gall bladder removal or hip replacement, could become high-risk, and some cancer or bowel surgery, and certainly organ transplants, might be so unsafe that nobody dared carry them out. Even removing a minor skin cyst could be life-threatening - we could be, as David Cameron put it, "cast back into the dark ages of medicine".
In October 2014, Public Health England identified a 12% increase in the number of drug-resistant E.Coli infections in the blood over a four-year period. Obviously this is just one example and overall under 1% of bacteria are resistant to multiple drugs in the UK - but in countries like India, the incidence is closer to 10-20%.
Worryingly, Public Health England also identified a 6% increase in the number of antibiotics prescribed during the same 4 year period in the UK. Some of this may be down to our ageing population, and the increase in conditions like COPD, but they estimate that up to half of these may be prescribed inappropriately. There are lots of reasons for this - GPs may be partly responsible, because in the days of increasing litigation they may be tempted to prescribe 'just in case'.
But every day I am faced with patients demanding antibiotics, completely convinced that they 'know their own bodies', 'need them because it may just be a cough now, but I always get a chest infection if I don't get them'… the list is endless. I've lost count of the number of consultations where I've explained to the patient that they have a viral infection and there is no evidence whatsoever that antibiotics will help, only for them to explain that they have a wedding/work commitment/stressful commitment/holiday that they just have to be better for. They seem to imagine that I have the magic cure, and if they can come up with a compelling enough reason I will open my magic prescribing pad and give them the cure.
In fact, even many bacterial infections get better just as quickly on their own as they do with antibiotics. And antibiotics have side effects - feeling sick, tummy pain, diarrhoea, sun-sensitive rash, inflammation of the oesophagus and life-threatening allergic reaction, to name but a few. They're also the most common cause of the serious bacterial infection Clostridium difficile, or C .diff as it's sometimes called. This germ usually causes problems, which can be life-threatening, in sick hospital patients who have recently had antibiotics. Here at least there is some good news. One of the few antibiotics to be developed in recent years is fidaxomicin, specifically designed to treat C.diff, seems to be making inroads into controlling an infection with a high rate of recurrence. A new study of almost 1,500 'patient episodes' of C.diff infection, treated in the UK with fidaxomicin or older antibiotics such as vancomycin or metronidazole, has shown promising results. For instance, in two hospitals where fidamoxicin was used first line, death rates were between 3.1 and 6.3%, compared to comparable rates of 17-18% in hospitals using other antibiotics.
But there are so many more bacteria out there than C.diff - and if we keep prescribing too many antibiotics without developing new ones, any one of them could become the new MRSA. Doctors have to resist the temptation to prescribe, and all of us have to learn to take no for an answer where antibiotics are concerned. And no, there is never a good enough excuse to get them 'just in case'.