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CPD - Case-based: rational prescribing of antibiotics

This case-based module will guide you through the latest evidence in the area of sensible antibiotic prescribing

Learning Objectives

To update you on: 

  • The evidence based assessment of a patient with a sore throat 
  • How to assess a patient with a cough, with or without the use of a CRP machine 
  • How to treat a patient with cellulitis and when to consider admission 
  • How to handle a patient who wants antibiotics for a dental problem 
  • The evidence based management of UTI, including when to dip and send a urine sample and when to treat empirically 
  • Which patients with otitis media should have antibiotics

Author

Dr Toni Hazell is a GP in North London

The 1928 discovery of penicillin was one of the most important developments of modern medicine, although it took some years for the significance to be understood and it was not until 1945 that Alexander Fleming received his Nobel prize1. Fast forward several decades and there is concern being raised that we may be on the brink of a post-antibiotic era. A 2018 report form the Organisation for Economic Co-operation and Development (OECD) noted that around 17% of bacterial infection in OECD countries are resistant to antibiotics, with this number rising to a third in some countries. They predict 2.4million deaths due to antimicrobial resistance (AMR) in Europe, Australia and North America between now and 2050.

The Center for Disease Control in the United States has a similarly gloomy outlook, telling us that there are two million cases of resistant bacteria in the United States every year, causing at least 23,000 deaths.3 Around 74% of all antibiotics prescribed in the UK are given in primary care4, with over half of those being for respiratory tract infections. We know that 85% of those with a sore throat will be symptom free within a week without antibiotics5, yet many patients with a sore throat are convinced that they have tonsillitis (or ‘strep throat’ if they hail from across the pond) and feel short-changed if they leave without a prescription. This module will discuss the rational evidence-based use of antibiotics in primary care, using NICE and other resources and signposting to downloadable resources that can be given to patients.

Case study 1 – Miss F

Miss F is a 21 year old woman who you are seeing in your Monday morning on call session. She has had a sore throat for four days and tells you that she is ‘prone to tonsillitis’ and ‘always gets antibiotics to nip it in the bud’. She is newly registered with you and looking back at her previous notes you can see that her previous GP does have a fondness for antibiotics, as Miss F has had five prescriptions in the last 18 months, all for upper respiratory tract infections. You decide to take some more history and to examine her.

What scoring systems are you aware of for assessing patients with a sore throat?

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