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GP's and Antibiotic Prescribing

Cleoriff
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GP's have been praised for the reduction in antibiotic prescriptions they give to their patients. Over prescribing of this drug leads to 'superbugs' (MRSA is one) which will NOT respond to any antibiotic currently available.

In theory this appears to be an excellent move.

Viral infections such as colds or flu will not respond to antibiotics

Bacterial infections do respond to antibiotics. Here is the article....

http://www.bbc.co.uk/news/health-36372617

Now I am going to put my medical hat on here. This is excellent news IF the patient is presenting with a viral infection and it remains viral. However I have seen many many instances where something that appears as viral in the first instance... ..develops later on to become a bacterial infection. So if someone visits their GP and is refused antibiotics, they must have their condition monitored in case it worsens.. ie a cold (virus) turning into chronic  bronchitis ( possibly bacterial)

Interesting to note this in the article above "this success (in reduction of antibiotics prescribed) is also down to money. GPs have been paid to reduce their use of antibiotics". 

Don't get me wrong. I was a ward manager when MRSA hit my ward... it caused chaos and the ward had to be closed and treatments cancelled. So I am all for selective management of antibiotics..if patient safety is never compromised.

 

 

Veritas Numquam Perit

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jonsie
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So, if we now have superbugs which are immune to antibiotics then apart from GPs wasting their time prescribing them at all, just how are we to overcome these bugs? Surely the only long term answer is to develop new antibiotics? Or will the bugs stop being immune to the present ones if we no longer use them?

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PhoneDoc
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MRSA is resistant to a group of the most commonly used antibiotics known as beta lactams, these would include drugs like penicillin and amoxicillin.
As the source of the majority of MRSA infections is hospitals (there'll always be a ready supply of hosts) and the resistance gives a biological advantage, it's unlikely resistance to these drugs will fade over time.
Fortunately there are a few classes of antibiotics that MRSA is sensitive to, especially a class called glycopeptides, such as Vancomycin. As you've suggested though, new drugs are indeed in development to provide a wider selection of treatments (and hopefully improve outcomes). They'll also act as a fail safe should Vancomycin also become resistant.
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Beenherebefore
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waiting

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Cleoriff
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With due respect to anyone posting here ...you all should know that I have had years to acquire my knowledge and relevant qualifications in the medical/nursing and research profession....so I am speaking from 45 years experience. I went into nursing as a cadet at 15 and worked my way to the most senior position in the NHS Trust. I am not bragging in anyway shape or form I am just stating a fact. The hospital I worked in was the first one recognised to have the MRSA infection in the UK. MRSA is most commonly known as hospital acquired but actually can be carried on the skin of anyone....They will only affect the immuno compromised. We have developed antibiotics which can treat MRSA...but once those are over prescribed they are no longer effective as a new strain of resistant bacteria will develop... Three times in the UK...we have reached a point when we had NO antibiotics available...The latest one Carbapenem‐Resistant Enterobacteriaceae (CRE) is still causing major problems. However lesson over...I still remain concerned that GP's will not prescribe antibiotics when a viral infection worsens and becomes bacterial..

 

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PhoneDoc
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S'all good @Cleoriff, I'm not contradicting you, just contributing to the discussion by attempting to answer some of the good questions that@jonsie raises about MRSA treatments. It's an interesting topic, cheers for posting the link.

Other than managing antibiotics from outside sources (such as agriculture and developing countries), is there anything we could be doing differently here in the UK to better manage antibiotic resistance?

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Cleoriff
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I honestly think we are doing as much as we can. Every hospital now has a Control Of Infection department...with specialist staff visiting areas frequently and promoting good hygiene. I know work is ongoing  globally with information sharing....some developing new antibiotics...others looking at increasing preventative measures. After our outbreak I was seconded to three teaching hospitals to see the work they were doing in those C.O.I depts

To stop the spread of antibiotic-resistant bacteria, we should continue promoting regional efforts in which hospitals, long-term care facilities and other health care areas communicate regularly about infections,

Many antibiotic-resistant bacteria spread in a community because they are carried by patients from one facility to another. In our hospital we realised it started with one patient who was transferred to us from another one. (Her previous environment had not tested her...they saw no need...she was from our area. It was a simple transfer)

However, to link back to the article. I do worry if GP's have a cash incentive to .reduce antibiotic prescribing...there could be a chance they don't give it when necessary?

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PhoneDoc
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So as far as secondary care goes, one of the biggest threats to the spread of resistant infections may be a small group of individuals not maintaining the same high standards that otherwise should limit infections?

I think from a primary care perspective, there wouldn't be too much to worry about when it comes to bonuses for reducing antibiotic prescription. From what I've read, the biggest of these bonuses are for reducing broad-spectrum, second line antibiotics (such as co-amoxiclav and quinolones), that really shouldn't be used as empirical treatment for minor infections in the first instance.

I can't see general practictioners forgoing antibiotics where indicated. To think of it selfishly, they risk a breakdown of communicaiton with their patient that will prevent other successful interventions (such as BP/cholesterol lowering and smoking cessation), further reducing their own bonus. They'd also open themselves up to regulatory and legal proceedings. From an ethical standpoint, I've never met a GP who would want to put financial gain ahead of the interest of their patient's needs

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Cleoriff
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Knowing a lot of GP's, I would say, as with every profession, there are good and bad...

Some may not ask the patient to present themselves back to surgery if condition worsens. There are pressures on all GP's whether involving patient overload, pressure to meet targets or monetary restrictions from the government and Primary Care Trusts. I have many friends who are Practice Nurses who are working flat out to undertake duties that previously were the responsibility of hospitals or clinics. If there are money incentives to cut down on antibiotic prescriptions....with all other factors considered, I know for a fact some patients will be overlooked.

Doctors are gods in the eyes of some.....and if Dr said NO antibiotics required, there any many who would not return to surgery if their condition deteriorated and the viral infection became something else. Have you heard that old expression 'I suppose I have to feel worse before I get better?' It happens now @PhoneDoc I am sure it will only get worse.....

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Martin-O2
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This is really good news! I know that it's been a while since new antibiotics have been discovered so anything that's done to slow the build up of resistance in bacteria is a good thing. 

 

I think there is still a problem with over prescribing antibiotics in farming, especially in the US. Hopefully something can be done to address this too.

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