Saturday, 13 June 2015

Antibiotics - why I almost never prescribe them

Recently, during a session where I was teaching a large group of primary care nurse practitioners, one of the students interrupted and asked, "So, do you just never prescribe antibiotics?"  This was on about the third face to face day of the Core Principles module of the Paediatrics in Primary Care Diploma at Sheffield Hallam University.

When it comes to the issue of prescribing antibiotics in the various clinical scenarios we discuss on the course, I bring a fairly non-interventional approach.  My rationale for this is not however based on the reasons that I was taught when I was a medical student or even a GP trainee.  My avoidance of antibiotics comes from the simple realisation that they cause so many problems and are very rarely the solution to the presenting scenario.

This week I was asked to provide a guest blog for Johnathan Laird who has a site which gives practical advice about therapeutics in general.  Without hesitation I submitted my 10 reasons to avoid antibiotics in children.  None of the ten reasons are to do with resistance or oral thrush.  Here are two of the reasons:

Although it is probably my most strongly worded piece, I would like to add that I have without a doubt prescribed antibiotics that were not needed and that caused many of the problems listed.  All that I am trying to do is to be clear about why we should avoid antibiotics.  I do realise that a 100% appropriate prescribing rate is a nonsense.

So in answer to my student, I do prescribe antibiotics about three times every month.  Once for a pneumonia where the child is well enough to be treated at home, once for a urinary tract infection and once for a soft indication such as a throat or ear infection.  For the pneumonia and UTI the denominator is one, whereas for ears and throats the denominator is about fifty.  So do I just never prescribe antibiotics?  Not never but certainly with a high threshold and that threshold exists for ten good reasons.

Edward Snelson
Winner of the Connecticut State Science Fair

Disclaimer:  If my children so much as sneeze I give them broad spectrum antibiotics.  Any self respecting doctor does the same for their children.

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