Stop Prescribing Antibiotics

[taxexile]

from the uk press , but due to the prescribing practices here , relevant to thailand.

<H1>STOP GIVING ANTIBIOTICS FOR COLDS

By Rebecca Smith, Medical Editor

Last Updated: 2:09am GMT 09/01/2008

Doctors are to be told to stop prescribing antibiotics for coughs, colds and sore throats because over-use of the drugs is fuelling the spread of killer hospital superbugs.

Alan Johnson, the Health Secretary, says it is time to end the unnecessary use of penicillin and other commonly-prescribed pills, which cost the NHS £1.7 billion a year.

Using antibiotics too liberally has led to bugs such as MRSA becoming resistant to treatment with the drugs. Most colds, coughs and flu are caused by viruses, which cannot be treated with antibiotics anyway, Mr Johnson points out.

Announcing a £270 million campaign against superbugs, to be launched next month, he says it is vital that doctors adopt "less of a knee-jerk reaction to prescribing".

The campaign, called Clean, Safe Care, will also include an extra £45 million for hospitals to spend on infection control nurses or antibiotic specialist pharmacists. All patients going into hospital will be screened for MRSA by 2009.

Staff have already been told they must be "bare below the elbows" to help prevent the spread of infection between patients and all hospitals should undergo a "deep clean" by March this year, although experts have dismissed this as a gimmick.

Mr Johnson says: "The past 60 years have seen great advances in health care and medicine. For example, the use of antibiotics has saved countless lives, but antibiotics do not work on most coughs, colds and sore throats and their unnecessary use can leave the body susceptible to gut infections like C. difficile.

Over-use of antibiotics, which can be used only on bacterial infections, has been blamed for the rise of drug-resistant tuberculosis. The drugs can strip natural bacteria from the gut and allow C.diff to take hold and kill vulnerable elderly people.

Too-liberal use of antibiotics, especially when patients do not finish their courses, allows multiplication of bugs that have mutated to become resistant.

If antibiotic use is not curbed, doctors could run out of effective treatment as certain bugs become resistant to more and more drugs. Pharmaceutical companies are unwilling to invest the billions of pounds needed to research and develop new antibiotics because they are not very profitable.

Dr Mark Enright, professor of molecular epidemiology at Imperial College London, said even common bacterial infections do not really need treating with antibiotics and usually go away on their own.

"In the old days, before we had problems with resistance, people thought it really didn't matter - you could throw antibiotics at these cases and you would pick up the odd one that was treatable that way," he said.

"I am sure there are still GPs who think they know best and think antibiotics are the global panacea we once thought they were."

The most common antibiotic ingredient, amoxicillin - one of the penicillin family - has become less effective because more bugs have become resistant to it. Other common generic antibiotic ingredients that are less effective include cefaclor, used for chest infections, and trimethoprim, used to treat urinary tract infections.

Prof Kevin Kerr, consultant microbiologist at Harrogate District Hospital, said the pressure on GPs to prescribe antibiotics can be immense. In some cases patients are told by one doctor in the practice that they do not need antibiotics only for them to book with another partner who is more willing to capitulate.

He said: "These campaigns are desperately needed. The focus has been on cleanliness and washing hands but without closing the circle by tackling prescribing it is only half the battle."

Norman Lamb, the Liberal Democrat health spokesman, said: "The Government has ignored the link between antibiotics and hospital infections for too long. Over-prescribing of broad-spectrum antibiotics is very dangerous."

</H1>

[lopburi3]

While I do not disagree with the push to lower non specific use of antibiotics, and agree it is a huge problem here (mostly because testing can not be done so shotgun approach is used) can not help but get the the feeling this may be more about "which cost the NHS £1.7 billion a year" than saving lives in the UK. Actually I did not think it was a serious problem in the UK where I would suspect most doctors would be well aware of the problems of over prescribing.

[PhilHarries]

My experience with Thai people is that if they come away from the doctors or hospital without at least six different kinds of pills they'll go see another and get some more. Thailand is going the same way with overprescription and that, coupled with lack of basic health education is going to be a future health problem for any tropical country where bugs of all types thrive.

Norman Lamb, the Liberal Democrat health spokesman, said: "The Governments hashave ignored the link between antibiotics and hospital infections for too long. Over-prescribing of broad-spectrum antibiotics is very dangerous."

Not just the current one but all previous governments are similarly to blame.

[lannarebirth]

I worry about things like this and consequently have not ingested any antibiotics (except once in a hospital after surgery). I have a couple of questions if I may for the medical professionals here. Does not taking antibiotics personally make the antibiotic more efficacious when it is needed, or is it the fact that everyone else takes too many that makes it less efficacious for all? Also, I DO sometimes use topical antibiotic ointment for cuts. Does that also reduce the effectiveness of future antibiotics should I be in need of them? TIA

[percy2]

To be fair to Dr's. and hospitals , I would guess that the great majority of antibiotics in Thailand and prescribed by Pharmacists.

Cheers

[samran]

For me it isn't so clear cut.

While I do agree with not overprescribing, getting the flu in LOS seems to be a different matter for me.

When I get a cold or flu here in Thailand, it tends to hang around for about a month. I try and hold out, usually for up to around two weeks, where I then go to the doctor, and end up getting the anti-biotics as the flu has turned into a throat infection where it is impossible to swollow, or brochitis has developed. No amount of sleep, rest, water etc etc seems to help on its own.

Compare this to getting the flu back in say OZ or the UK. My experience there is you take a day or two off, hunker down under some warm blankets, eat lots of chicken soup and sleep the thing off. By day three, you are definetly on the mend. This same approach has never worked here in Thailand in the time I've been here.

[Phil Conners]

You might want to boost your immune system with some vitamins during the flu period ...

[samran]

You might want to boost your immune system with some vitamins during the flu period ...

sorry, I should have been clearer. When I said "No amount of sleep, rest, water etc etc " seems to help, the etc etc included a treasure trove of vitimans, berocca and echinacha (sp?), which I take copious amounts of while sick -all for very little benfit.

[AlexLah]

What docter in the world prescribes anti biotics against common cold or flu?

Type in Google : cause of flu/common cold

You should educate yourself a bit as well when doctors prescribe anything, look up the name of medicine given and check what it does.

Do not always believe a doctor, specially not here in Thailand as I personally found out twice living here.

[moldy]

Agreed. Antibiotics are over prescribed.

But there is may be a tendency now to hold back too long, eg, Joe has a cold. Hard luck Joe antibiotics won't work even if the cold is a week old - it's a virus dummy. But 1 more week on Joe has a runny nose and sinus pain, feels hot. Well the cold has gone surely, Joes tubes are still irritated and he may have a slow bacterial build up that might lead to infected rhinitis, sinus infection, tonsilitis or even bronchial infection. Under these circumstances time for the antibiotics in small measure ?. Can't see a 3-5 day course would do any harm !. Yes in time. the condition would be self limiting and the antibiotics aren't strictly necessary, but anybody who has suffered sinus infection for a month or so will tell you that it can be a dam_n miserable time which can cause other problems. And after all, this is the sort of problem antobiotics were invented for.

Just because something starts out viral, doesn't mean that the problem some time on isn't bacterial, and I get a bit worried when qualified people get caught up in dogma, rather than common sense. Maybe web sites might need to take this on board.

Surely a gold standard could be set- no antibiotics for 2 weeks. Not exactly a difficult concept to grasp or adhere to.

Be interesting to hear what a health prof. has to say though as I could be talking codswallop and wouldn't want to spread misinfo.

A very good posting, with some good replies particularly about the Thai ' bag of candy medicines'. It's horrendous when you think about it. I think Thai treatment takes the 'lets throw a lot of mud at the wall in the hope that some sticks' approach.

I think postings like this with healthy discussion to follow do a great service.

[moldy]

For me it isn't so clear cut.

While I do agree with not overprescribing, getting the flu in LOS seems to be a different matter for me.

When I get a cold or flu here in Thailand, it tends to hang around for about a month. I try and hold out, usually for up to around two weeks, where I then go to the doctor, and end up getting the anti-biotics as the flu has turned into a throat infection where it is impossible to swollow, or brochitis has developed. No amount of sleep, rest, water etc etc seems to help on its own.

Compare this to getting the flu back in say OZ or the UK. My experience there is you take a day or two off, hunker down under some warm blankets, eat lots of chicken soup and sleep the thing off. By day three, you are definetly on the mend. This same approach has never worked here in Thailand in the time I've been here.

A very sensible, pragmatic approach as it applies to all us Bangkok dwellers and I agree wholeheartedly.

Incidentally, you may want to take acetylcysteine on a regular basis, possibly danzen too. These are cheap natural remedies with no implications used in the long term I believe. Check your nose out, a lot of probs lower down start out as a post nasal drip. If so would recommend nasal rinsing with squeezy bottle of saline solution.

[Tony Clifton]

Yup, I was also surprised that I was prescribed antibiotics at almost every visit to he doctor's or hospital.

I'd say about 10 prescriptions by now in 5 years when I had taken antibiotics only once before in 40 years...

Asian prosperity at any cost.

Edited January 9, 2008 by Tony Clifton