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Why antibiotics shouldn't be overused

The nights are drawing in, the weather's taken a turn for the worse and unfortunately many of us are battling a seasonal cold or cough. It also means that your local GP surgery is full to burst with concerned patients asking for antibiotics. But they're likely to be disappointed.

Why? It's not because your GP doesn't care about you! Doctors know they need to reduce the number of antibiotics they prescribe in their surgeries. Overuse of this type of medicine has led to regular health scares, from MRSA to cases of blood poisoning (septicaemia) that don't respond to treatment.

What is antibiotic resistance?

Bacteria are very clever - they evolve through the generations. If one germ is 'born' better equipped to cope with attacks on it, it's more likely to survive and pass on its genes to its offspring.

But bacteria can multiply every few minutes, rather than every few years like humans. They can also produce hundreds of offspring. That means evolution happens with terrifying speed.

This is what we mean by 'antibacterial resistance' and we should all be concerned about it. Recent headlines have warned of disaster on the horizon, a world where simple cuts or minor surgery are fatal. We're not there yet, but we can all do our bit to cut antibiotic resistance without risking our health.

One way is to not always expect to receive an antibiotic for an illness which is typically caused by a virus - not bacteria. You've guessed it: that's coughs, colds, sore throats and ear infections.

The other is for GPs not to feel pressured into prescribing this type of medicine when it's not necessary. The CMO Network, powered by Bupa, has signed a pledge that urges doctors to prescribe antibiotics only when truly needed.

Antibiotic resistance

Modern medicine relies on antimicrobials - and antibiotics in particular. They treat life-threatening infections and are vital to many medical advances, from basic surgery, to heart transplants and chemotherapy. But, as bacteria develop resistance, antibiotics are starting to fail.

— Dr Paul Zollinger-Read, Chief Medical Officer, Bupa

Companies in the CMO Network employ around eight million people combined. Each signatory has committed to playing their part to help dramatically reduce the volume of antibiotics which are misused and, in turn, slow resistance among their workforce. They're doing their bit - now it's time for all of us to do ours.

More harm than good

It's important to know that antibiotics usually won't make you recover faster. Even if your bronchitis or ear infection is caused by bacteria, antibiotics are unlikely to get you better any quicker than your body's own immune system.

Antibiotics can also cause side effects such as diarrhoea, sickness and tummy pain that may be as bad as the condition we're trying to treat.

Everyone deserves the best treatment

Over the years, I've regularly been accused of not prescribing because I'm trying to save money. In fact, most antibiotics cost pennies - believe me, I could prescribe hundreds and not make a dent in my area's drug budget. Other patients assume it's because I don't think they 'deserve' them. But every patient deserves the best treatment - and the best treatment is one that will work, which antibiotics won't for viral infections.

The exceptions

But there are exceptions of course. If you cough up blood or rusty coloured sputum; get short of breath or wheezy; or have sharp, stabbing chest pain when you breathe (rather than just when you cough) you should see your doctor. Likewise, if your cough goes on for more than two weeks, you should get it checked out.

And some people are more likely than others to get bacterial infections. This includes a weakened immune system (cancer, cancer treatments and 'immune suppressing' treatments for conditions like rheumatoid arthritis or asthma. If you have chronic obstructive pulmonary disease (COPD) your GP may give you a course of antibiotics to keep and take as soon as you start coughing more, or bring up more or different coloured sputum. For people with these conditions or experiences, 'normal rules' about antibiotics may not apply - ask your GP if in doubt.

Sore throats

Dr Sarah Jarvis MBE

Sore throats, likewise, are usually caused by viruses. However, a sore throat without a cough; fever; tender glands on the front of your neck; and white spots on the back of your throat may spell bacterial infection; if you have three or more of these, or if your throat is too sore to swallow liquids, see your GP.

What antibiotics treat strep?

If you do have a bacterial infection in your throat, it's highly likely to be caused by streptococcus, commonly known as strep. Depending on your symptoms or whether you've had a positive swab, your doctor is likely to prescribe a 10-day course of penicillin V or, if you're allergic, five days of clarithromycin.

Acute sinusitis

Acute sinusitis is a miserable condition which can give rise to pain over your face (often worse when you lean forwards); a runny or blocked nose, fever, tiredness and bad breath. Unlike coughs and colds, it may take up to three weeks for acute sinusitis to settle. Painkillers and decongestant nose sprays (for up to five to seven days) or saline nose drops can help. Your pharmacist can help with all of these. So can warm face packs held over your sinuses. If your symptoms are accompanied by swelling around your face or eye, or bloodstained discharge, see your doctor.

What antibiotics treat a UTI?

If you do need antibiotics for a lower UTI, called cystitis, a three-day course (seven days for men) of trimethoprim, unless you're pregnant or allergic, will probably be your doctor's first choice. Nitrofurantoin, also taken for three days, is a common alternative.

Cystitis - inflammation of the bladder causing burning urine, needing to wee more often and low tummy pain - is much more common in women than men. Cranberry juice may help prevent it happening and sachets to de-acidify your urine (from your pharmacist) can relieve symptoms. If an attack goes on for more than three days, or you have severe symptoms, loin pain or high fever, see your GP.

Which antibiotics for a kidney infection?

Most kidney infections develop from the bladder infection cystitis. The germs travel up to your kidneys, causing pain in one or both loins, high fever, feeling sick and/or diarrhoea, and sometimes blood in the urine. Unlike cystitis, this needs prompt treatment, usually with co-amoxiclav or ciprofloxacin

Which antibiotics for a chest infection?

Chest, or respiratory tract infections are divided into upper (URTI) and lower (LRTI). URTIs are common colds - if you're otherwise healthy, you never need antibiotics for them. Bronchitis often doesn't need antibiotics, but pneumonia does. Amoxicillin, doxycycline or clarithromycin are the usual doctor's first choices.

Which antibiotics for toothache?

If you have toothache, don't ask your GP for antibiotics - they know no more about teeth than you do! See your dentist instead.

If in doubt: visit your pharmacist!

If you're not sure whether antibiotics are likely to be needed to treat your symptoms, your pharmacist should always be your first port of call. They're a mine of medical information with no appointment needed, and can advise on whether you need to see a GP. They also have far more 'self-help' remedies on offer than your doctor does!

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