UK: Doctors Should Go Easy on Antibiotics...

England’s National Institute for Health and Clinical Excellence (NICE) is urging doctors to NOT prescribe antibiotics for most cases of sore throats, colds, bronchitis, and most respiratory infections. Reuters reports:

They should also delay writing such prescriptions and reassure people the drugs are not needed immediately and would make little difference because most respiratory infections are viral, the new guidelines said.

"Management of respiratory tract infections in the past concentrated on advising prompt antibiotic treatment," Paul Little, who helped write the new guidelines, said in a statement.

"However, as rates of major complications are much less common in modern developed countries, so the evidence of symptomatic benefit should be strong to justify prescribing antibiotics so that we are not needlessly exposing patients to side effects."

The overuse of antibiotics is a growing concern for health officials worldwide as hospitals report an increasing number of drug-resistant bacteria such as methicillin-resistant Staphylococcus aureus, or MRSA.

MRSA infections can range from boils to more severe infections of the bloodstream, lungs and surgical sites. Most cases are associated with hospitals, nursing homes or other health care facilities.

The drugs watchdog said a quarter of people in England and Wales visit the doctor because of respiratory tract infections, which account for 60 percent of all antibiotic prescriptions in general practice.

This is a recurring topic. Dr. Fuhrman has strong opinions on prescribing antibiotics. He faults both doctors and pharmaceutical companies. Check it out:

Drug companies are a big part of this problem. They promote the use of their products through widespread advertising and the practice of giving free samples of the more potent, broad-spectrum antibiotics to doctors.

Most doctors perpetuate this problem because they give in to the pressure to prescribe antibiotics. They like to appear that they are offering an important and necessary service by writing prescriptions.

But Dr. Fuhrman would definitely agree with NICE’s recommendation. He insists antibiotics are appropriate for severe bacterial infections. Likes these:

  • Cellulitis
  • Lyme disease
  • Pneumonia
  • Joint infections
  • Cat bites
  • Meningitis
  • Bronchitis (in a long-term smokers)

Seems to me this strategy would really cut into the profits of drug makers.

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Comments (2) Read through and enter the discussion with the form at the end
Dr Kadiyali M Srivatsa - July 25, 2008 5:54 PM

Dr. Fuhrman is ill informed or has not worked as a doctor for a long time. I am surprised to hear him blaming doctors for the problem created due to antibiotic abuse.

Since 1970s drug companies did not invest in developing antibiotic and were never promoting their abuse. As a doctor working in NHS (25 years), I have never met a medical rep promoting antibiotic use

Patients were and still are refusing to listen to Gps who tell them not take antibiotics for coughs, cold, and flu. When I take time and advice, they do not listen. Often I find them calling out of hour’s doctors, visiting walk-in clinic or visit A&E to get antibiotic they think they need. I have seen this as a hospital doctors and am seeing this as a GP even today.

The Government must be blamed for allowing nurses to prescribe antibiotics in the last 10 years and creating the walk-in clinics. These nurses were given protocols to help prescribe. They were made to prescribe Penicillin as the first line for most URTI because the protocol published by NICE say so. These nurses can't even make out the difference between Flucloxacillin and Pencilline yet they are hailed as success and now are bringing in pharmacists to assist them.

What a shame!!

Joel Fuhrman, MD - July 27, 2008 8:12 PM

Dr. Srivatsa-

Welcome, and thanks for visiting and commenting. I hope you come back and contribute again. I have been a board certified family physician for 17 years and have over 10,000 family charts in those years. I think you are kidding yourself to blame nurses and patients for this problem and not doctors too. Besides my observations and experiences over the last 20 years as a physician, many medical studies document that doctors play a significant role in the overuse and abuse of antibiotics. But, I am glad to hear you are not one of them.

Antibiotic use and abuse in clinical practice. Pediatr Ann. 1999; 28(7):453-9. Nyquist AC

Antibiotic-use screening evaluations (ABUSE) for physicians and patients: featuring prizes and penalties for physicians. Infect Control Hosp Epidemiol. 2000; 21(12):796-9. Lettau LA

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