Antibiotic choice, resistance and stewardship

The modern antibiotic age first attributed to the discovery of penicillin by Alexander Fleming, then later the isolation and mass production by Australian Howard Florey has proven to be one of the single most revolutionary developments in science and medicine, saving lives and curing conditions that were previously lost causes.

But close to a century of use with initially little regard for the consequences of liberal use has brought us closer to what some scientists consider the post antibiotic era.

Put a group of GP’s in a room together, ask them what their pet peeves are and they might all yell in unison “antibiotics for viruses”. We know that antibiotics absolutely don’t work to fight against viruses. The common cold, influenza, hand foot and mouth. All nasty infections in their own right and can be quite dangerous. And we wish there was a pill we could give to eradicate them quickly. But antibiotics aren’t that answer.

But we get why people ask. Patients are sick, they want to get better. They wouldn’t have come to their GP if they didn’t need help.

And last time they used antibiotics – things got way better! How can this GP not know this?

And don’t get me wrong, we certainly do prescribe antibiotics – but we don’t take it lightly.

But why did my antibiotics help me last time?

There are a few explanations. The simplest one? You had an infection that required antibiotics and it got better.

It may have been acute bacterial sinusitis, or strep throat. And clearly your doctor thought it was severe enough to warrant the use of antibiotics in your situation.

Sometimes things just get better anyway. The typical cold lasts about 7 days, with the worst symptoms often being the first 2-3 days. You finally feel sick enough to see the doctor – who may have given you some antibiotics. You take them and you feel better the next day. 2+2 = 4.

But had you just waited, chances are (and these are some h2 odds), that you get better the next day anyway.

And finally some antibiotics help not because they fight the infection, but they can carry some anti-inflammatory properties, similar to ibuprofen.

So should I avoid antibiotics then?

No, there are definitely some conditions that require antibiotics to improve your illness.

Cellulitis often does not improve without antibiotics.

If you feel you don’t need your antibiotics – ask.

Sometimes we use antibiotics in a way people don’t expect. For example in tonsillitis (a condition that often doesn’t NEED antibiotics), the misconception is that it will make you better immediately. The truth is it will cut about 1 day off a severe episode of tonsillitis.

The reason we used antibiotics for tonsillitis is to prevent the secondary effects of streptococcus, which can cause rheumatic fever.

So no, don’t avoid all antibiotics. But ask what benefit does it provide in your situation, what are the side effects, and do I really need them?

Antibiotic resistance

Resistance to antibiotics has a few misconceptions. People may be under the impression that they develop a resistance. Ie, penicillin no longer works for me.

The medical profession also used to believe that not finishing a course of antibiotics led to resistance as well. It’s not wrong, more of a half truth. It would be more accurate to say that ineffectively treating an infection leads to resistance. So using the wrong antibiotics, or using the right ones but stopping before you’ve recovered.

The video above explains how if the choice and strength of antibiotic isn’t appropriate to control the infection, it becomes less effective the longer you use it. It is important to note that you don’t personally become resistant to that antibiotic, and not every throat infection becomes resistant, but that particular organism can develop resistance.

The coming of a post antibiotic era

This is probably one of the scariest things facing medicine. An era where we have no effective antibiotics.

In the last 60 years, we’ve only developed 2 new classes of antibiotics. The rest have been tweaks on old and existing medicines. And currently resistance is fast outpacing successful development of novel treatments.

In the USA more people die in hospitals of Methicillin Resistant Staphylococcus Aureus than of AIDS and Tuberculosis combined.

And although a lot of basic science research is being conducted in new and novel ways to fight infections, it may be a long time before they are proven to work in a safe way.

So essentially, the post antibiotic era may be similar to the pre-antibiotic era.

Why are you posting this? This is terrifying!

We don’t mean to make people super anxious. But sometimes I think it’s lost on us all how seriously we need to take it. It can be so much easier to give someone that antibiotics for that sore throat that won’t go away, or the cough that keeps bothering them. It’s easier than spending the extra time explaining why the cough is there and how to improve it while preventing resistance.

And when you feel unwell, you just want that pill that will make life better. And if you’ve taken the time out of a day of feeling terrible to go into the doctor and they tell you it’s a virus, you may feel ripped off. You might even get angry. We’ve all had patients get angry at us before when we know the only thing an antibiotic would do is give them a rash or diarrhoea and not improve their symptoms at all.

So it’s just to get us all thinking. The next time you’re unwell, come and get checked out to make sure nothing else is going on. But if your doctor says you don’t need antibiotics right now, they didn’t take that decision lightly. It won’t mean you won’t need antibiotics later, but we have to see how things progress.

And it’s never just a virus. The Spanish flu was a virus. Smallpox and polio are viruses. This year influenza outbreak was due to a virus. We’re not fobbing you off, but if the cure is rest and symptom control, then it is what it is. If things get worse or don’t follow the expected course, speak do your doctor.

Our Specialties

Green Square Health provides a range of services to fulfil the needs of our community.
Please find more information on the pages below about our services and tips on how to stay healthy.