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GPs can't solve antibiotic resistance by themselves

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And so the topic of antibiotic resistance has reared its ugly, pus-filled head on social media. Public Health England is running a campaign to encourage members of the public, healthcare professionals et al to become ‘antibiotic guardians’.

The powers that be need to do more

On the website, in true NHS fashion, you have an option of 17 categories in which you can become a guardian. If you select ‘Primary Care Prescribers’, for example, you can pledge to ‘review my practice prescribing against that of the CCG and national averages on fingertips’. It beats pledging to sit in a bath of beans, at least. Perhaps most disappointingly was the list of pledges for the ‘Government’ option, which failed to include ‘fund the NHS properly’.

In the comments section on the post which inspired this muse, there are two fiercely opposed camps. On the one hand, patients are to blame for insisting, nay demanding, that little Boris needs antibiotics for his snotty nose. On the other, useless GPs dish them out like skydiving forms as the doctor-patient interaction equivalent of an eject button.

So who is to blame? I suppose that’s the point. So long as we all remain human and find it difficult to be critical of our own actions, we will all look to other parties to start taking responsibility. Until we can move past that issue, it’s going to be extremely hard to work together to deal with the very serious problem of antibiotic resistance. Given that relying on this fundamental change in human nature is as likely as having a CAMHS referral accepted, the powers that be need to do more. A passage from American microbiologist Hans Zinsser, in his book ‘Rats, Lice and History’ gives the perfect analogy:

‘Infectious disease is merely a disagreeable instance of a widely prevalent tendency of all living creatures to save themselves the bother of building, by their own efforts, the things they require. Whenever they find it possible to take advantage of the constructive labours of others, this is the path of least resistance.’

The Government needs to protect GPs from indemnity and defamation in the press and social media for not prescribing antibiotics. Patients need access to more information about the real problem of antibiotics – not from us, because that is not working – but from ‘the man’. A helpline, TV adverts, a man in an MRSA costume scaring children at schools would all seem more effective than a pledge to do something ourselves. We simply cannot do it ourselves.

Dr Danny Chapman is a locum GP in east and south Devon

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Readers' comments (12)

  • I must admit I do find it concerning that there has been a steady rise in childhood sepsis and scarlet fever alongside the fall in antibiotic prescribing. Perhaps those red throats weren't viral after all?

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  • I'm not an epidemiologist or microbiologist, but I would love to have something explained to me. I understood antibiotic resistance to be a genetic response to confrontation with an antibiotic. This occurs either through mutation or plasmid transmission? Now surely, by virtue of the fact that these antibiotics exist in the world alongside bacteria, it is INEVITABLE that most antibiotics will become useless AT SOME POINT. By slowing down prescribing, we delay this process, but we cannot stop it. Meanwhile, because newer antibiotics are guarded so closely, there is a lot less money to be made in developing new ones, as the returns are so small during the lifetime of the licence. It seems like we're doomed to fail eventually. Let's make hay while the sun shines! I jest obviously, but I do wonder why we don't get many new agents, compared to 20-30 years ago. I'd be interested in the evidence basis for this policy, genuinely.

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  • Dear All,
    Antibiotic resistance in the UK is due to prescribing by vets in agriculture, literally thousands of tons of teh stuff each year. Antibiotic resistance in e-coli and other bugs has its resevoir in chickens, cows and pigs.
    Regards
    Paul C

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  • I have had to take antibiotics every so often for years now for the pneumonias I regularly get after having my tonsils removed when I was a child.
    I hate taking antibiotics because they make me feel so unwell for weeks after, but I am lucky they existed otherwise I would certainly not be here now.
    However I have been looking at alternatives in the natural world and I actually managed to treat a recent pneumonia with supplements alone. It has taken me years of trying to work out how to do it, and reverting to antibiotics every time I failed, but now I managed it and a week or two later I feel fine without any rotten gastric or other side effects. Yay!
    So when antibiotics stop working, as it seems they will at some stage, there are some natural alternatives out there.

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  • Antibiotics are widely given in animals as growth promotors to make more profit. They should find another set of chemicals to fatten animals up and not waste antibiotics for this purpose. The problem is that unfortunately for farmers, most of the chemicals used to fatten up animals have been banned. These are the thyroid hormone blockers, the steroids (well these are still used to some extend worldwide), the carbamates etc....
    Antibiotics remain as one of the few cheapest legal chemicals to fatten up animals and while this is the case, this practice of widespread use of antibiotics will continue.

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  • @7:45 what you've described there is regression to the mean for a viral, self limiting condition. No amount of natural remedies can achieve what amox/gent/met can do for raging sepsis. Turmuric/garlic/citrus etc all have benefits as being antiseptic (one of the reasons they dominate a lot of cuisine) but these things cannot be used in lieu of antibiotics in established infection where eventual sepsis is a real possibility. If you want to appeal to the current trend of 'natural' products being more attractive, remember most antibiotics are derived from natural sources.

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  • Hi i am 7.45am and I agree that antibiotics are the drugs of choice for a massive systemic sepsis. However amoxycillin does not work for me due to years of taking in in childhood, metformin and gentamycin gave me pseudomembranous collitis. So while these work for many, we need alternatives for those it does not work for due to resistance or poor sode effect reactions. Luckly fluclox still works for me and saved my life 4 years ago from a truly life threatening sepsis.
    The more options we have, the better prepared we will be for the future where there are few if any functioning antibiotics.
    The good thing about spices and herbals is that they kill all bugs whether they are resistant or not to antibiotics. They work in different ways and are not as simple as having iv injections etc... but what is the alternative?

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  • It's difficult to find translatable knowledge from your case - the key is funding for further antibiotic development (probably using natural bacteriostatic/bacteriocidal agents such as those that you use as a source of further developments). The difficulty w. herbals/spices/OTC preps is the lack of consistency with dosage, purity, and presence of other contaminants. I didn't mean to be disparaging - antibiotics more so than a lot of medication classes, have strong roots in traditional/nautral therapies - but we'd probably be struck of for recommending natural therapies for infections due to potential complications.

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  • What about Vets ?! You can't take a pet to a vet without them filling them up with antibiotics. I wrote to Dame Sally Davies about this and she replied that it was not her concern. Far easier to blame GPs

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  • SCIENCE did an article on this last year. 80% of antibiotics are used by farmers the world over esp USA and China. Antibiotics get into the world stream thus. We GPs use a minuscule amount of the worlds antibiotics.
    Direct me to one single paper which shows antibiotic resistance is due to us GPs.
    We must antibiotics judicially, no doubt, but blame lies elsewhere.
    It is the problem with so called freedom of the press, which they use to be flat track bullies and badger people with no way of reply and no hope of fairness.
    Imagine calling us lazy, for example, when we do 80 hour weekends on little sleep.
    The British press are just bullies that spread misinformation under the guise of freedom.

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