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Antibiotics Friday, 8 October, 1999, 17:25 GMT 18:25 UK
When 'no' is the hardest word
By BBC Doctor Colin Thomas

We are living in the age of a pill for all ills - a result of the optimism born in the scientific revolution of the late fifties, sixties, and seventies.

We were convinced that the white heat of technology would provide an answer for everything, and this was only perceived as good. The same happened in medicine.

Penicillin had been around since the thirties, but with advances in pharmaceutical engineering antibiotics became more available, and the public was enticed into believing they were a cure-all.

And because the NHS is still essentially "free", patients believe they are "entitled" to these treatments. It has only been recently that the problems of indiscriminate antibiotic usage have been addressed.

Choice of pills

Thumbing through the British National Formulary there are at least 70 different antibiotics. All the better, you might say.

But the reason for the constant quest for new drugs is that the older types are becoming less useful due to antibiotic resistant bugs. And the more different antibiotics you use, the worse it can get.

I was a general practitioner before antibiotic prescribing guidelines were thought about, and, to be honest, I felt like a criminal when I wasn't giving people antibiotics for their ills.

I have always believed that our own immune system should be allowed to deal with infections, reserving antibiotics for the difficult cases, but it is very difficult to resist demands.

I think patients believed it was a plot to stop them having something they were entitled to, whereas in fact it was an attempt to practise good medicine.

In some cases good medical practice is knowing when to do nothing, which is a difficult concept for many people to grasp.

Spot the indulged patient

I was particularly taken aback by a patient who had just joined the practice.

He had been prescribed antibiotics on and off for some years because of mild folliculitis - spots to you - where his trousers rubbed on his upper thighs.

It really was not a serious condition, and the most I would have suggested would have been local antiseptics and certainly not antibiotics.

But he was adamant that was what he wanted, so against my better judgement I gave in.

Today with the new antibiotic guidelines to back me up it would be a different story.

Kiss of life

Although antibiotics are considered safe, this is not always true. A female medical colleague of mine had just finished a gruelling weekend on call and had been troubled by a toothache.

Doing what all good doctors shouldn't, she asked a colleague to prescribe her some antibiotics, and hastily swallowed them before the ward round.

A few minutes later she started to feel queasy, hot, and faint and conked out flat on the ward floor.

Of course she was in the right place to have a serious allergic reaction . . . and she even got the kiss of life from the dishy registrar she fancied, but she was lucky.

So my advice? If you go to your doctor and he doesn't prescribe an antibiotic, think yourself lucky.

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28 Sep 99 | Health
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