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At the heart of general practice since 1960

Two-day observation would curb antibiotic prescribing

The news report on increased antibiotic resistance in high-volume prescribing practices (May 5) raised the following thoughts.

For about 100 million years, the mammalian immune system has evolved to repel all microbial attacks. It is powerful, specific and memorises every one of hundreds of bacterial assaults it has encountered in each individual.

In comparison, all antibiotics are weak, crude and all induce resistance. Antibiotics also disrupt the body's normal flora and allow colonisation by pathogens which the normal flora exclude.

Those GPs who are high-volume prescribers should review the adequacy of their knowledge and in most cases of URTI and UTI, and should consider a two-day observation period before prescribing an antibiotic. That period will allow the body to mount an immune response, and research has repeatedly shown the recurrence rate of the same infection is reduced greatly where the antibiotic has been delayed (compared with recurrence when an antibiotic has been prescribed at once). A two-day observation period also results in the spontaneous recovery of about 85 per cent of infections.

To finish where I begun, the human body has been carrying its own infection pretty well for a very long time, and when the antibiotic era is over (c. 2020), the body will continue to do so in most cases.

Professor Hugh McGavock

Cloughmills, Co. Antrim

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