Overuse Of Antibiotics?

[USNret]

I've been sick all week & then got sicker, so finally we went to see the doctor. It was at one of the nicer hospitals in BKK.

I get some lab tests done, chest x-ray and exam then the doc says, Good news, it's not the flu, it's bronchitis. He then gives a variety of prescriptions: 3 to ease coughing, pain & fever, plus an antibiotic that I will take once a day for 7 days. He says I'll be feeling better in 3 days (which is tomorrow, and I'm already better).

Anyway, I go home and just for fun I google bronchitis. What I learn from that fount of all knowledge, wikipedia, is that "Most cases of acute bronchitis are caused by viruses, therefore antibiotics are not generally recommended as they are only effective against bacteria." It goes on the say the disease will generally cure itself; you need only to treat the symptoms (cough & fever).

So I'm thinking WTH? If this is caused by a virus, and antibiotics are only good for bacteria, then why am I taking antibiotics? I'm sure we are all familiar with the dangers of over-using antibiotics which lead to creation of antibiotic-resistant diseases, and doctors are generally urged not to do that.

What I'm wondering is, is this common in Thailand? Do they prescribe antibiotics willy-nilly in case it might somehow help? And despite the fact that I'm better, I think basically the disease has run it's course plus I've got other medications for my comfort.

[lvdkeyes]

I have found that, not only do Thai doctors over prescribe antibiotics, but Thais go to the pharmacy and buy antibiotics for any little thing. I knew a guy who bought antibiotics because he had been caught in the rain. I knew the pharmacist well and asked him to explain to this guy that he should not be taking antibiotics for such a reason. He tried to convince him, but to no avail. Down the road this country is going to have a major health crisis because of over medicating people.

[Sheryl]

Overuse of antibiotics is indeed common in Thailand. That said, your blood tests results would have provided an indication as to whether or not a bacterial infection was present.

Also worth noting that when viral infections are prolong, bacterial superinfection is not uncommon.

[USNret]

Ivdkeyes, I agree this will (and probably already is) leading to a public health problem. There is a campaign in the States to help doctors resist their patients' insistence on antibiotics when it is clearly not indicated. No such mandate here.

Cheryl, thank you for sharing that. Anyway, I'm being good & taking my daily pill. I know the importance of completing the prescription to the end. My only other complaint about my doctor is that he can't say "flu". He said: "Now I'm gonna check you for foo" and I'm think, oh no... this is where I drop my drawers. But not so!

[utalkin2me]

I think your question has been well answered. The new question then becomes..... do competent doctors over-prescribe antibiotics? I know my answer, everyone must decide for themselves I guess.

[xylophone]

It is probably true that worldwide doctors prescribe antibiotics more than they should do, but at least there is some sort of control because a doctor has to be seen in the first instance, whereas here anyone can walk into a pharmacy and buy antibiotics.

What always worried me was the fact that the "bar girls" at a few friends of mine's bars would go into the pharmacy with any sort of problem, ranging from head colds to STDs and buy antibiotics, however they would buy the cheapest available because they didn't have a lot of money to spend on such things, and they would only buy a few days worth – – more worrying was the fact that the pharmacist would be complicit in this.

Unfortunately this is just the tip of the iceberg because well over 70% of the antibiotics produced worldwide are given to animals in their feedstock, so we are unwittingly becoming antibiotic resistant by eating them. Please see the information below from the Council
for Agricultural Science and Technology (USA). AND this is scary!!

Quote: Antibiotics have been used in animal feed for about 50 years ever since the discovery not only as an anti-microbial agent, but also as a growth-promoting agent and improvement in performance. Tetracyclines, penicillin, streptomycin and bactrican soon began to be common additives in feed for livestock and poultry. Currently, the following antibiotics are used in livestock and poultry feed: chlortetracycline, procaine penicillin, oxytetracycline, tylosin, bacitracin, neomycin sulfate, streptomycin, erythromycin, linomycin, oleandomycin, virginamycin, and bambermycins. In addition to these antibiotics, which are of microbial origin, there are other chemically synthesized antimicrobial agents that are also sometimes used in animal feeds. These include three major classes of compounds: arsenical, nito-furan, and sulfa compounds. Arsenical compounds include arsanilic acid, 3-nitro-4-hydroxy phenylarsonic acid, and sodium arsanilate; nitro-furan compounds include furazolidone and nitro-furazone; sulfamethazine, sulfathiazole, and sulfaquinoxaline. Other chemicals are also used as antiprotozoal agents to prevent coccidiosis and histomaniasis in chickens and turkeys

[partington]

Very true, and scary. Countries like Thailand where you can buy antibiotics over the counter are a major risk for the spread of antibiotic resistance, as well as the antibiotics in foods.

A major problem is both can cause antibiotic resistance in common bacteria that are always in your body. This itself is harmless, but bacteria have the capacity for horizontal transmission of resistance, that is, they can transmit the resistance they have developed to other species of bacteria. So if you get infected with disease-causing bacteria your harmless resistant bacteria can render the disease-causing ones antibiotic-resistant.

It's also true that most bronchitis is caused by viruses not bacteria, and even if your sputum is yellow or green this does not indicate a bacterial cause. Furthermore doctors almost never test for whether your infection is bacterial or not. Patients like to be prescribed antibiotics, so they just get them, and the problem continues.

But you rarely need them, because they do nothing for viral infections, and even bacterial infections, like the viral ones, are self-limiting - you get better in a week or two. Although taking antibiotics can give a mildly beneficial effect, research shows that the average result is that they make you feel better about 0.6 days, or just about 12hrs sooner than if you didn't take them at all. In fact a recent study from Southampton university actually showed that one commonly used antibiotic, amoxicillin, was no better than a placebo for treating bronchitis http://www.futurity.org/health-medicine/for-bronchitis-antibiotic-no-better-than-placebo/

This benefit is so small , and the risks of increasing antibiotic resistance for really serious disease so real, that doctors in the UK are advised not to routinely prescribe antibiotics for chest infections http://cks.nice.org.uk/chest-infections-adult#!supportingevidence1

• Duration of symptoms: taking an antibiotic reduced the duration of feeling ill by a mean difference -0.64 days (95% CI -1.16 to -0.13).
• The authors concluded that although antibiotics were seen to be of benefit in people with acute bronchitis, the magnitude of this benefit has to be weighed against the disadvantages of antibiotic use including adverse effects, medicalisation of a self-limiting illness, the risk of resistance developing, and the cost of treatment.

So the best thing to do is just refuse to take antibiotics for a chest infection, and do some good for the world. And I say this as a saintly figure who has just had a three week bout of acute, green slime-producing bronchitis, that made me feel dreadful, but I trusted the science and refused to buy antibiotics and treat myself. For the good of humanity

[xylophone]

To put an even scarier local (to me anyway) scenario to this, I read an article about 18 months ago which said that the incidence of antibiotic resistant gonorrhoea in Phuket was now running at around 30%!!

This report puts this down to the overuse of antibiotics, and another report points to the fact that Amoxicillin and Zithromax, which were once held out to be the first line of defence against this disease, and which can be bought at will over the counter here, are fast becoming obsolete against gonorrhoea in some countries.

[kriswillems]

There are also a few benefits of getting cheap antibiotics over the counter.

People that normally wouldn't go to see a doctor because they have no money or time for it can also get better.

Many Thai people go to the local pharmacy to get medicines themselves. They tell the pharmacist what the symptoms are and they get something.

As soon fever is mentioned you always get antibiotics (which is in 99% of all case Amoxcillin, a cheap broad spectrum antibiotic) and paracetamol.

Despite the disadvantages of the use of too much antibiotics, I think many lives have been saved this way in Thailand.

Would they forbid to sell antibiotics over the counter many people would only go to see a doctor when the infection reaches a very serious level and more people would die.

[jrtmedic]

kriswillems

On the contrary there are NO benefits to be gained from the irresponsible use of antibiotics!

In much of the third world a huge and insurmountable problem is in the process of being generated by the ill-informed use of these drugs most of which are sold by shop assistants NOT Pharmacists.

Many infections/diseases are now becoming virtually untreatable (for example TB and Gonorrhoea)

"Pharmacists" in the third world are not diagnosticians and are not trained to prescribe any form of medication.

Most if not all Western States are aware of the dangers of the misuse of antibiotics and the World Health Organisation (WHO) actively encourages restraint in the use of these precious drugs.

The potentially disastrous situation is widely recognised by Western Governments. Unless antibiotic use is actively controlled, within the foreseeable future mankind will be returned to the pre-penicillin days, routine surgery will be extremely risky and people will die from previously curable afflictions.

Ignorance coupled with little knowledge is indeed very dangerous !

All Thai people have access to the 30 Baht heath care scheme -----there is no excuse for turning to "pharmacies" for other than the most minor of health care issues. Westerners who prefer to self medicate should know better and are responsible for adding to the problem.

Whilst the Thai medical profession turn to readily to prescribing antibiotics they are only a reflection of what occurred in the West in the not to distant past. Increasing pressure from the WHO. , improved on-going education and the ever increasing difficulty of treating infections will result in a change of practise. Let us all hope that this occurs sooner rather than later.

Edited May 7, 2013 by jrtmedic

[kriswillems]

You're probably right.

Still, even if there's the 30 card, people here don't go to see a doctor unless they are in a very serious condition - they just go to a pharmacy.

The people that go to a pharmacy are still the lucky ones, because some also go to the local fortune teller or medicine man.

I know this is not good, but that is how things are.

Taking into account the lack of education, superstition and lack of responsibility we should be happy the pharmacies are there to help the group that almost systematically refuses to see a doctor.

In this country many people with HIV are dying young because they don't take their medicines .... that's how much doctors and modern science are trusted here.

If they wouldn't sell antibiotics over the counter starting from to tomorrow, do you think that people will suddenly change their habit and start seeing a doctor when they have a serous infection? I think not. They will just switch to Thai herbs.

Also, if you go with a fever to any doctor in Thailand, the doctor will give you paracetamol and amoxcilin ... so, what's the difference between the doctor and the pharmacist?

There's a lot of work to do on the education front, both of the doctors and the people.

[utalkin2me]

You're probably right.

Still, even if there's the 30 card, people here don't go to see a doctor unless they are in a very serious condition - they just go to a pharmacy.

The people that go to a pharmacy are still the lucky ones, because some also go to the local fortune teller or medicine man.

I know this is not good, but that is how things are.

Taking into account the lack of education, superstition and lack of responsibility we should be happy the pharmacies are there to help the group that almost systematically refuses to see a doctor.

In this country many people with HIV are dying young because they don't take their medicines .... that's how much doctors and modern science are trusted here.

If they wouldn't sell antibiotics over the counter starting from to tomorrow, do you think that people will suddenly change their habit and start seeing a doctor when they have a serous infection? I think not. They will just switch to Thai herbs.

Also, if you go with a fever to any doctor in Thailand, the doctor will give you paracetamol and amoxcilin ... so, what's the difference between the doctor and the pharmacist?

There's a lot of work to do on the education front, both of the doctors and the people.

Doctors are in fact feared here. I wonder why. Could it be because through their life Thais have had friends with seemingly minor ailments, and came back from the doctor maimed, or worse? There are no repercussions here for performing poorly, at least not out in the sticks.

Anyway, the point of the thread is over-prescribing of antibiotics. It is no doubt happening. In fact, I personally can't remember a time I have been to a doctor here where he did not try to give me some. To me, it borders on outright ineptitude to not study your craft enough to know when not give them. We'd get mad as hell if a plumber came into our house and put in the wrong pipe.... but not when a doctor prescribes the wrong medication for our bodies??

[kriswillems]

I had a small infection on my thumb. There doctor opened it and got the puss out. I got amoxilin and paracetamol.

My body turned red. I had hunderds of red spots and I had a fever. The doctor was not sure what I had. I was given paracetamol and amoxillin.

I was throwing up for 2 days. The doctor gave me some salt based sports drink, paracetamol and amoxcillin.

I had a really bad cold and my throat hurt, I had a very light fever. I got an antihistaminicum, amoxcillin and paracetamol.

In each and every case those 2 medicines seemed to help and I got better quickly.

This was all with different doctors. I don't think I ever went to a doctor and didn't get those 2 medicines.

I have tried to tell the doctor I still have 20 packs of paracetamol and amoxcillin at home (in Thai), but that never helped much. I was always given a new sheet.

I also have no idea why I need to get paracetamol when I don't hurt and don't have a fever.

The doctors just think they are doing good by killing a mosquito with a cannon.

Edited May 9, 2013 by kriswillems

[xylophone]

Quote kriswillems: "Also, if you go with a fever to any doctor in Thailand, the doctor will give you paracetamol and amoxcilin ... so, what's the difference between the doctor and the pharmacist"?

With respect that is one key element that you seem to be missing – – if a Thai goes to a doctor, then the doctor will write out a prescription for the antibiotics or whatever, to be taken over a given timeframe with a given number of tablets, so when this is presented to the pharmacist, the pharmacist has to dispense that amount.

If a Thai goes to the local pharmacy and "it is decided that antibiotics are needed" then the Thai can put 100 baht on the counter and get as many tablets as that will buy, and the pharmacies in general will dispense the amount that can be bought, and therein lies the problem. Overuse of antibiotics is one major problem and coupled with that is the fact that under use (or not taking the correct dosage) of them has exactly the same outcome in as much as the bugs become antibiotic resistant.

As I said in an earlier post I have seen this countless times here over the years.

[kriswillems]

Unless you go to boots or watsons, you'll get one sheet, which has 10 pills of 500 mg on it. I think the price is around 40B. I never got a full box. There might be under usage and people might take the pills when not necessary (also when they go to see a doctor). But, I think it's hard to overuse when you get only 10 pills.

In Europe we always get much more pills than really necessary (there are about 40 pills in a box) and it's easier to take more pills than the doctor prescribed. When I was living there I had much more left-over medicines. One of the positive points of Thai pharmacies compared to european pharmacies is that you can buy pills in the amount you really need. A negative point is that you've to go to look on the internet for the information leaflet. It's seldom included with the medicines, even not in the most expensive private hospitals.

Edited May 10, 2013 by kriswillems

[robblok]

I had a small infection on my thumb. There doctor opened it and got the puss out. I got amoxilin and paracetamol.

My body turned red. I had hunderds of red spots and I had a fever. The doctor was not sure what I had. I was given paracetamol and amoxillin.

I was throwing up for 2 days. The doctor gave me some salt based sports drink, paracetamol and amoxcillin.

I had a really bad cold and my throat hurt, I had a very light fever. I got an antihistaminicum, amoxcillin and paracetamol.

In each and every case those 2 medicines seemed to help and I got better quickly.

This was all with different doctors. I don't think I ever went to a doctor and didn't get those 2 medicines.

I have tried to tell the doctor I still have 20 packs of paracetamol and amoxcillin at home (in Thai), but that never helped much. I was always given a new sheet.

I also have no idea why I need to get paracetamol when I don't hurt and don't have a fever.

The doctors just think they are doing good by killing a mosquito with a cannon.

Of course not.. the hospital makes money on the medicine they prescribe that is the reason.

[utalkin2me]

I had a small infection on my thumb. There doctor opened it and got the puss out. I got amoxilin and paracetamol.

My body turned red. I had hunderds of red spots and I had a fever. The doctor was not sure what I had. I was given paracetamol and amoxillin.

I was throwing up for 2 days. The doctor gave me some salt based sports drink, paracetamol and amoxcillin.

I had a really bad cold and my throat hurt, I had a very light fever. I got an antihistaminicum, amoxcillin and paracetamol.

In each and every case those 2 medicines seemed to help and I got better quickly.

This was all with different doctors. I don't think I ever went to a doctor and didn't get those 2 medicines.

I have tried to tell the doctor I still have 20 packs of paracetamol and amoxcillin at home (in Thai), but that never helped much. I was always given a new sheet.

I also have no idea why I need to get paracetamol when I don't hurt and don't have a fever.

The doctors just think they are doing good by killing a mosquito with a cannon.

Of course not.. the hospital makes money on the medicine they prescribe that is the reason.

Of course they do. They also make money when they try to schedule a follow up before you leave, on their time frame. That is always the one that gets me.... come back and give up more money for nothing, oh, and do it when WE can, not when you can. lol. Many doctors here should change their job title to "conveyor belt perpetuators".

[robblok]

I had a small infection on my thumb. There doctor opened it and got the puss out. I got amoxilin and paracetamol.

My body turned red. I had hunderds of red spots and I had a fever. The doctor was not sure what I had. I was given paracetamol and amoxillin.

I was throwing up for 2 days. The doctor gave me some salt based sports drink, paracetamol and amoxcillin.

I had a really bad cold and my throat hurt, I had a very light fever. I got an antihistaminicum, amoxcillin and paracetamol.

In each and every case those 2 medicines seemed to help and I got better quickly.

This was all with different doctors. I don't think I ever went to a doctor and didn't get those 2 medicines.

I have tried to tell the doctor I still have 20 packs of paracetamol and amoxcillin at home (in Thai), but that never helped much. I was always given a new sheet.

I also have no idea why I need to get paracetamol when I don't hurt and don't have a fever.

The doctors just think they are doing good by killing a mosquito with a cannon.

Of course not.. the hospital makes money on the medicine they prescribe that is the reason.

Of course they do. They also make money when they try to schedule a follow up before you leave, on their time frame. That is always the one that gets me.... come back and give up more money for nothing, oh, and do it when WE can, not when you can. lol. Many doctors here should change their job title to "conveyor belt perpetuators".

I don't see the problem with a follow up I had a bad sinus problem and follow ups were necessary and they tested how i reacted to different kind of treatments. They know how long it will take for a medicine to start to work so they know the time frame.

[xylophone]

Quote kriswillems: " Unless you go to boots or watsons, you'll get one sheet, which has 10 pills of 500 mg on it. I think the price is around 40B. I never got a full box. There might be under usage and people might take the pills when not necessary (also when they go to see a doctor). But, I think it's hard to overuse when you get only 10 pills".

What I was also trying to point out was that misuse/underuse of antibiotics is just as bad as overprescribing, meaning giving antibiotics when they are not necessary. In your example, if one could indeed buy 10 amoxicillin 500 mg pills for 40 baht then that would not be enough to cure most infections. So for 40 baht you would have enough for just over three days, which is well below the recommended dose and timeframe, therefore the infection doesn't get completely cured and you can get antibiotic resistant bacteria because of this underuse/misuse. And not to put too fine a point on it, when the infection comes back, the girls do exactly the same again.

That is the danger of selling antibiotics over-the-counter without having a doctor involved, and that was my point, because I have seen it happen time and time again

[partington]

Quote kriswillems: " Unless you go to boots or watsons, you'll get one sheet, which has 10 pills of 500 mg on it. I think the price is around 40B. I never got a full box. There might be under usage and people might take the pills when not necessary (also when they go to see a doctor). But, I think it's hard to overuse when you get only 10 pills".

What I was also trying to point out was that misuse/underuse of antibiotics is just as bad as overprescribing, meaning giving antibiotics when they are not necessary. In your example, if one could indeed buy 10 amoxicillin 500 mg pills for 40 baht then that would not be enough to cure most infections. So for 40 baht you would have enough for just over three days, which is well below the recommended dose and timeframe, therefore the infection doesn't get completely cured and you can get antibiotic resistant bacteria because of this underuse/misuse. And not to put too fine a point on it, when the infection comes back, the girls do exactly the same again.

That is the danger of selling antibiotics over-the-counter without having a doctor involved, and that was my point, because I have seen it happen time and time again

Yes! This is exactly right. The point is, when you go to a doctor in the west, and they prescribe antibiotics, they give you an exact number, a full course designed to completely eliminate the infection based on the particular antibiotic used.

They are always careful to instruct the patient to take ALL the tablets, and not to stop until they are all gone, and this is usually written on the bottle too.

This is specifically to avoid what xylophone is referring to: not taking enough antibiotic during the infection to kill all the bacteria, and so actually causing the most resistant ones to survive, giving a population of more resistant ones than you started with.

Pharmacists and patients in Thailand who treat themselves are not aware of this however, and so even when they have an infection that can be treated by antibiotics (probably 10% or less of the time they are actually used) they can take them in doses that are too small, and so make development of resistance even more likely!

Edited May 10, 2013 by partington

[robblok]

Quote kriswillems: " Unless you go to boots or watsons, you'll get one sheet, which has 10 pills of 500 mg on it. I think the price is around 40B. I never got a full box. There might be under usage and people might take the pills when not necessary (also when they go to see a doctor). But, I think it's hard to overuse when you get only 10 pills".

What I was also trying to point out was that misuse/underuse of antibiotics is just as bad as overprescribing, meaning giving antibiotics when they are not necessary. In your example, if one could indeed buy 10 amoxicillin 500 mg pills for 40 baht then that would not be enough to cure most infections. So for 40 baht you would have enough for just over three days, which is well below the recommended dose and timeframe, therefore the infection doesn't get completely cured and you can get antibiotic resistant bacteria because of this underuse/misuse. And not to put too fine a point on it, when the infection comes back, the girls do exactly the same again.

That is the danger of selling antibiotics over-the-counter without having a doctor involved, and that was my point, because I have seen it happen time and time again

Yes! This is exactly right. The point is, when you go to a doctor in the west, and they prescribe antibiotics, they give you an exact number, a full course designed to completely eliminate the infection based on the particular antibiotic used.

They are always careful to instruct the patient to take ALL the tablets, and not to stop until they are all gone, and this is usually written on the bottle too.

This is specifically to avoid what xylophone is referring to: not taking enough antibiotic during the infection to kill all the bacteria, and so actually causing the most resistant ones to survive, giving a population of more resistant ones than you started with.

Pharmacists and patients in Thailand who treat themselves are not aware of this however, and so even when they have an infection that can be treated by antibiotics (probably 10% or less of the time they are actually used) they can take them in doses that are too small, and so make development of resistance even more likely!

I have been to a few doctors in Thailand and never ever did they say complete the course or talk about the risks of stopping early. So in a way they are not much better as pharmacists.

[Sheryl]

This is unfortunately true of many average Thai docs, and many of them do in fact prescribe sub-therapeutic antibiotic regimens as a matter of course. In particular this is what your average GP here will do.

However it is quite possible to find doctors with better levels of training and expertise if you take the time to do some checking of qualifications.

[xylophone]

Quote kriswillems: " Unless you go to boots or watsons, you'll get one sheet, which has 10 pills of 500 mg on it. I think the price is around 40B. I never got a full box. There might be under usage and people might take the pills when not necessary (also when they go to see a doctor). But, I think it's hard to overuse when you get only 10 pills".

What I was also trying to point out was that misuse/underuse of antibiotics is just as bad as overprescribing, meaning giving antibiotics when they are not necessary. In your example, if one could indeed buy 10 amoxicillin 500 mg pills for 40 baht then that would not be enough to cure most infections. So for 40 baht you would have enough for just over three days, which is well below the recommended dose and timeframe, therefore the infection doesn't get completely cured and you can get antibiotic resistant bacteria because of this underuse/misuse. And not to put too fine a point on it, when the infection comes back, the girls do exactly the same again.

That is the danger of selling antibiotics over-the-counter without having a doctor involved, and that was my point, because I have seen it happen time and time again

Yes! This is exactly right. The point is, when you go to a doctor in the west, and they prescribe antibiotics, they give you an exact number, a full course designed to completely eliminate the infection based on the particular antibiotic used.

They are always careful to instruct the patient to take ALL the tablets, and not to stop until they are all gone, and this is usually written on the bottle too.

This is specifically to avoid what xylophone is referring to: not taking enough antibiotic during the infection to kill all the bacteria, and so actually causing the most resistant ones to survive, giving a population of more resistant ones than you started with.

Pharmacists and patients in Thailand who treat themselves are not aware of this however, and so even when they have an infection that can be treated by antibiotics (probably 10% or less of the time they are actually used) they can take them in doses that are too small, and so make development of resistance even more likely!

I have been to a few doctors in Thailand and never ever did they say complete the course or talk about the risks of stopping early. So in a way they are not much better as pharmacists.

This has been written on every antibiotic prescription I have ever had here......."antibiotic drug, take until finished". Sorry to hear about your experiences.

[kurnell]

I always took antibiotics for bronchitis because I was coughing up giant green lugies. Clearly bacterial.

[partington]

I always took antibiotics for bronchitis because I was coughing up giant green lugies. Clearly bacterial.

It's not true that green or yellow sputum means that the infection is definitely bacterial - this happens with viral infections as well.

For example, in one recent study http://www.ncbi.nlm.nih.gov/pubmed/22034649 they found green sputum had bacteria in it 59 out of every 100 times, and yellow sputum had bacteria in it 46 out of every 100 times.

They concluded that it is more likely that you have a bacterial infection if your sputum is yellow or green than if your sputum is white, but it is not a confirmation that you have a bacterial infection as it's wrong half the time.

A Swedish study of 241 patients from 42 GPs also came to the same conclusion by comparing sputum colour and testing the sputum for bacteria: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410464/. They concluded:

"Discoloured sputum in patients with acute respiratory infections may lead to the prescription of antibiotics.

• This study investigates the correlation of discoloured sputum in patients with acute cough and a bacterial aetiology.
• The findings imply that the colour of sputum or discharge cannot be used to differentiate between viral and bacterial infections in otherwise healthy adults.
• The colour of sputum should not be used to make a decision on whether to prescribe an antibiotic within this group of patients."

Many other studies show the same thing.

[jrtmedic]

Antibiotics are not sweeties they are in fact (or were) an extremely powerful weapon against pathogenic bacteria.

The misuse of these drugs by some doctors, pharmacists and patients has weakened the "weapon" and we are now living in a world where the bacteria are gradually winning the war. However, all is not lost IF we respect and use antibiotics appropriately.

For antibiotics to be used appropriately it is necessary in the first instance to secure an accurate diagnosis of a condition which may be amenable to treatment with an antibiotic. Most coughs, earaches , sore throats, sinusitis and diarrhoea only require symptomatic/supportive treatment NOT antibiotics. Similarly most "clean" wounds, isolated abscesses and similar conditions do not require treatment with antibiotics.

Once a diagnosis has been made an informed decision has to be made about which bacteria may be causing the problem.

From this point an appropriate antibiotic can be chosen (all antibiotics have a different "spectrum" of activity -- for example some may exhibit positive activity against some bacteria but not others).

When choosing an appropriate antibiotic the prescriber needs to have knowledge of local sensitivity patterns (For example , in Thailand Gonorrhoea may not be sensitive to treatment with previously effective drugs ---in other words the organism has become resistant to those drugs.)

In some instances it may be necessary to commence antibiotic therapy against a "best guess" whilst at the same time samples are sent to a laboratory where the causative organism can be positively identified together with the most effective antibiotic for treatment. This process takes on average 1-3 days and may result in the need to alter any prescribed antibiotic regime.

Most antibiotic abuse occurs outside hospitals and is associated with relatively minor illnesses.

As I have observed before unless a more responsible approach is taken. by health care professionals and patients in the use of antibiotics mankind faces a bleak future.

Make no mistake the "bugs" will win the war if we continue to abuse the gift of antibiotics.

[utalkin2me]

Antibiotics are not sweeties they are in fact (or were) an extremely powerful weapon against pathogenic bacteria.

The misuse of these drugs by some doctors, pharmacists and patients has weakened the "weapon" and we are now living in a world where the bacteria are gradually winning the war. However, all is not lost IF we respect and use antibiotics appropriately.

For antibiotics to be used appropriately it is necessary in the first instance to secure an accurate diagnosis of a condition which may be amenable to treatment with an antibiotic. Most coughs, earaches , sore throats, sinusitis and diarrhoea only require symptomatic/supportive treatment NOT antibiotics. Similarly most "clean" wounds, isolated abscesses and similar conditions do not require treatment with antibiotics.

Once a diagnosis has been made an informed decision has to be made about which bacteria may be causing the problem.

From this point an appropriate antibiotic can be chosen (all antibiotics have a different "spectrum" of activity -- for example some may exhibit positive activity against some bacteria but not others).

When choosing an appropriate antibiotic the prescriber needs to have knowledge of local sensitivity patterns (For example , in Thailand Gonorrhoea may not be sensitive to treatment with previously effective drugs ---in other words the organism has become resistant to those drugs.)

In some instances it may be necessary to commence antibiotic therapy against a "best guess" whilst at the same time samples are sent to a laboratory where the causative organism can be positively identified together with the most effective antibiotic for treatment. This process takes on average 1-3 days and may result in the need to alter any prescribed antibiotic regime.

Most antibiotic abuse occurs outside hospitals and is associated with relatively minor illnesses.

As I have observed before unless a more responsible approach is taken. by health care professionals and patients in the use of antibiotics mankind faces a bleak future.

Make no mistake the "bugs" will win the war if we continue to abuse the gift of antibiotics.

Short version translation (so sorry to be arrogant enough to put words into your mouth): the typical Thai doctor 6 minute prognosis of "take these anti-biotic pills and come and see me again in one week" aint going to do us any favors, now or in the long haul.

[kurnell]

I always took antibiotics for bronchitis because I was coughing up giant green lugies. Clearly bacterial.

It's not true that green or yellow sputum means that the infection is definitely bacterial - this happens with viral infections as well.

For example, in one recent study http://www.ncbi.nlm.nih.gov/pubmed/22034649 they found green sputum had bacteria in it 59 out of every 100 times, and yellow sputum had bacteria in it 46 out of every 100 times.

They concluded that it is more likely that you have a bacterial infection if your sputum is yellow or green than if your sputum is white, but it is not a confirmation that you have a bacterial infection as it's wrong half the time.

A Swedish study of 241 patients from 42 GPs also came to the same conclusion by comparing sputum colour and testing the sputum for bacteria: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410464/. They concluded:

"Discoloured sputum in patients with acute respiratory infections may lead to the prescription of antibiotics.

• This study investigates the correlation of discoloured sputum in patients with acute cough and a bacterial aetiology.
• The findings imply that the colour of sputum or discharge cannot be used to differentiate between viral and bacterial infections in otherwise healthy adults.
• The colour of sputum should not be used to make a decision on whether to prescribe an antibiotic within this group of patients."

Many other studies show the same thing.

The anti-biotics, always cured my bronchitis

[MAJIC]

Very true, and scary. Countries like Thailand where you can buy antibiotics over the counter are a major risk for the spread of antibiotic resistance, as well as the antibiotics in foods.

A major problem is both can cause antibiotic resistance in common bacteria that are always in your body. This itself is harmless, but bacteria have the capacity for horizontal transmission of resistance, that is, they can transmit the resistance they have developed to other species of bacteria. So if you get infected with disease-causing bacteria your harmless resistant bacteria can render the disease-causing ones antibiotic-resistant.

It's also true that most bronchitis is caused by viruses not bacteria, and even if your sputum is yellow or green this does not indicate a bacterial cause. Furthermore doctors almost never test for whether your infection is bacterial or not. Patients like to be prescribed antibiotics, so they just get them, and the problem continues.

But you rarely need them, because they do nothing for viral infections, and even bacterial infections, like the viral ones, are self-limiting - you get better in a week or two. Although taking antibiotics can give a mildly beneficial effect, research shows that the average result is that they make you feel better about 0.6 days, or just about 12hrs sooner than if you didn't take them at all. In fact a recent study from Southampton university actually showed that one commonly used antibiotic, amoxicillin, was no better than a placebo for treating bronchitis http://www.futurity.org/health-medicine/for-bronchitis-antibiotic-no-better-than-placebo/

This benefit is so small , and the risks of increasing antibiotic resistance for really serious disease so real, that doctors in the UK are advised not to routinely prescribe antibiotics for chest infections http://cks.nice.org.uk/chest-infections-adult#!supportingevidence1

• Duration of symptoms: taking an antibiotic reduced the duration of feeling ill by a mean difference -0.64 days (95% CI -1.16 to -0.13).
• The authors concluded that although antibiotics were seen to be of benefit in people with acute bronchitis, the magnitude of this benefit has to be weighed against the disadvantages of antibiotic use including adverse effects, medicalisation of a self-limiting illness, the risk of resistance developing, and the cost of treatment.

So the best thing to do is just refuse to take antibiotics for a chest infection, and do some good for the world. And I say this as a saintly figure who has just had a three week bout of acute, green slime-producing bronchitis, that made me feel dreadful, but I trusted the science and refused to buy antibiotics and treat myself. For the good of humanity

You are lucky to have a strong pair of lungs,some people with diseased lungs such as Emphesema,couldnt wait for the chest infection to run it's course,and are prescribed Antibiotics,on an emergency basis.

[Sheryl]

The recommended management of bronchitis and other respiratory infections in people with COPD (emphysema) differs from that in people without chronic lung disease.