What’s all the fuss about antibiotics?

By Dr. Ramesh Mehay, GP Ashcroft Surgery

What are antibiotics?

Antibiotics are medicines that are used to kill or inhibit a class of bugs called bacteria in order to cure infections in people and animals (yes, vets use them too!).

Watch this video to understand the threat of antibiotic resistance

So if they kill or inhibit bacteria which cause infections, why can’t I have them for my cough or cold?

The problem is that coughs and colds are caused by a different class of bugs called viruses.   Antibiotics only work against bacteria, not viruses.  Therefore if you take them, you are simply wasting your time.  And if you did take them even just to try – not only would you be wasting your time but there are two other things you should consider…

  1. First, most antibiotics cause side effects.  Therefore, you are likely to suffer side effects (like diarrhoea, vomiting, generally feeling like rubbish) whilst on the antibiotic.  Do you really want to take the risk of this whilst you are recovering from your cough or cold?
  2. Secondly, by giving you antibiotics, we are likely to promote something called antibiotic resistance.  This will be a massive problem for you in years to come (or for your children and grandchildren).  Read more about this below.

Why do I get antibiotics for tonsillitis or a water infection then?

Tonsillitis and urine infections are often caused by bacteria.   Hence, antibiotics are given because they work against bacteria.  HOWEVER, did you know that the latest research says that many simple bacterial infections will resolve on their own WITHOUT antibiotics.   For example, a person recovering from tonsillitis who IS NOT given any antibiotics will get better in about 5-7 days.  Now, if we give that person antibiotics, they will get better a little quicker BUT ONLY BY HALF A DAY!!!   So, if you think you have tonsillitis or a water infection, please do things yourself first to see if that will help clear it.  For example, with tonsillitis, gargle with slightly salted warm water (one teaspoon salt in one glass of warm water).  If you have a water infection and you are female – drink plenty of water, perhap cranberry juice and buy some cystopurin from your local chemist.  If this doesn’t start to clear by day 3 or if you feel rotten, then by all means come in.

fluBut in the past I’ve had antibiotics and they’ve worked within 3-5 days

Did you know that most infections start to settle after 3-5 days.   Therefore, it is easy to see why a patient who takes antibiotics and then notices his or her infection starting to fade after 3 days might think the antibiotic is working.   But the reality of the situation is that the infection was going to settle anyway, even if they hadn’t taken those antibiotics.

But I know my chest and I always need antibiotics

We don’t argue with you when you say you know your chest.    But really, it is the doctor who has the medical knowledge and equipment to examine you who is best placed to decide whether an antibiotic is needed.  So why not leave it to them to decide, even if you have had loads of antibiotics before by previous doctors.  Remember, in the past, doctors gave out antibiotics more freely because we generally were not that concerned as we are today about antibiotics and resistance.  And yes, there are some medical conditions like COPD and asthma that often need antibiotics.  We are not saying that you don’t need them.  All we are saying is let your doctor make the decision because they are the most qualified person to do so (and by all means have a discussion but please don’t argue if they say no).

The NHS is always trying to save the pennies.  Seriously, isn’t the antibiotic thing all about money?

Trust us when we say this is DEFINATELY not about money.  Okay, let us ask you ONE question.  How much do you think a week’s supply of Amoxicillin ( a commonly given antibiotic) costs?   £30?   £25  £10   £5………   What do you think?   Actually all of these are wrong.  It costs about 30 pence.  That’s right, only 30 pence!   Yet loads of people are on blood pressure tablets and a one month prescription of ONE blood pressure tablet can easily cost £15 per month.  So, if you were in charge of the NHS, would telling doctors to stop using antibiotics save the most money?

At this point we would like to say three things….

  1. If a doctor feels (on clinical grounds) that you need a particular drug, they will give it.  It is unethical to do so.    Remember, we doctors go into this profession because we love people and we want to help them.
  2. If there is a drug that we think could help you, it will be given and the only time cost comes into it is if there is a similar drug that does exactly the same job but is cheaper, then we would use that.  Wouldn’t you?
  3. And finally, antibiotics are not given by doctors to patients ONLY when they honestly believe that the antibiotic would not help.  And this is not about cost.

Tell me more about this antibiotic resistance thing.

Bacteria (which cause infections) are killed or inhibited by antibiotics. But bacteria are clever little bugs.   The more they see that antibiotic, the more they are likely to adapt and protect themselves against them.   For example, if you were in charge of an tribe of people, and every year you fought against the same but different tribe of people and you knew they always used the same tactics to try and beat you, wouldn’t you tell your own army how you might beat them?   The same goes for bacteria – when they see the same drug again and again, they can genetically adapt and protect themselves from the killing action of the antibiotic.  These new type of bacteria are then called resistant strains (or in lay terms, super bugs).

Now, if we don’t pay attention to the antibiotic resistance problem, then (in the future) we are going to get thousands of different types of superbugs for which we don’t have antibiotics to kill them.

  1. If you’re under 60 – this will mean that in the next 15-20 years, you may end up catching simple infections which are caused by superbugs which we will have no antibiotics for.   And these superbugs will then be able to multiply and make your illness last longer or even cause your death.
  2. If you’re 70 and over and you think ‘Oh well, that won’t affect me, I’ll be dead by then anyway’, think about your children or grandchildren or their children.  Do you want to risk the possibility of them catching these superbugs and risking an early death?  This is the reality if we don’t do something now – while we still can.   And even if you have no children, shouldn’t we as human beings show kindness, compassion and consideration for one another?  After all, that is what unifies us as a human race!

How serious is the problem?

The situation is getting worse with the emergence of new bacterial strains resistant to several antibiotics at the same time (known as multidrug-resistant bacteria). Such bacteria may eventually become resistant to all existing antibiotics. Without antibiotics, we could return to the “pre-antibiotic era”, when organ transplants, cancer chemotherapy, intensive care and other medical procedures would no longer be possible. Bacterial diseases would spread and could no longer be treated, causing death.   In India, theres a bacteria that’s been discovered that is resistant to nearly all antibiotics!   That’s how scary the situation is.   Some are now even calling this the antibiotic apocalypse era (apocalypse means ‘an event involving destruction or damage on a catastrophic scale’).   But the good news is that we can do something about it now.   So, let your doctor decide whether you need an antibiotic, and don’t argue with them when they say no.

Is the problem worse than in the past?

Before the discovery of antibiotics, thousands of people died from bacterial diseases, such as pneumonia or infection following surgery. Since antibiotics have been discovered and used, more and more bacteria, which were originally susceptible, have become resistant and developed numerous different means of fighting against antibiotics. Because resistance is increasing and few new antibiotics have been discovered and marketed in recent years, the problem of antibiotic resistance is now a major public health threat.

What can be done to solve the problem?

Keeping antibiotics effective is everyone’s responsibility. Responsible use of antibiotics can help stop resistant bacteria from developing and help keep antibiotics effective for the use of future generations. On this basis, it is important to known when it is appropriate to take antibiotics and how to take antibiotics responsibly. Successful public awareness campaigns, which have already taken place in some countries, have resulted in a reduction of antibiotic consumption.  Everyone can play an important role in decreasing antibiotic resistance:

  • Follow your doctor’s advice when taking antibiotics.
  • When possible, prevent infection through appropriate vaccination.
  • Wash your hands and your children’s hands regularly, for instance after sneezing or coughing before touching other things or people.
  • Always use antibiotics under medical prescription, not using “leftovers” or antibiotics obtained without a prescription.
  • Ask your pharmacist about how to dispose of the remaining medicines.

What is the resistance situation in other regions in the world?

Inappropriate use of antibiotics is a problem worldwide. The World Health Organization (WHO) issued a global strategy and guidelines to help countries in setting up systems to monitor antibiotic resistance and to implement efficient actions (for instance, insuring that antibiotics can only be purchased with prescription). While people still die in developing countries because they lack the correct antibiotic treatment, antibiotic resistance resulting from inappropriate use is causing concern in every continent.

Specifically talking about MRSA

Bacteria are everywhere.   There live in our guts and outside on our skin.  Many are harmless and those in our guts actually do some good for us.  There is one bug called Staph Aureus (SA for short) which lives on all of our skin.  It usually causes no problem unless for example the skin is broken (through a cut for example) where it can then start infecting the inside of the skin – hence needed antibiotics.   However, Staph Aureus is one of the bugs that is becoming resistant to a group of antibiotics which contain methicillin.   These superbugs are called MRSA (Methicillin Resistant Staph Aureus) and it is a difficult bug to treat.  Typically, MRSA that is found in hospitals is resistant to many other antibiotics.  If it does get into the skin, it can cause infections that are so difficult to treat that the skin starts to break down really quickly.  Then, that infection can get into the blood stream and some people then die.   You may be wondering how you catch MRSA – MRSA is mainly acquired through direct contact from human to human or via equipment or medical devices. Antibiotic use is also associated with higher risk of acquiring MRSA.  How can I protect myself/my family from MRSA?
The most important thing to protect yourself and your family from MRSA is to comply with simple hygiene measures: clean and cover wounds, cuts and scrapes, keep your hands clean until they are healed, and avoid sharing personal items such as razors and towels. If you catch an infection due to MRSA, ask your doctor or nurse about which hygiene measures you and your family will have to comply with, in hospital and when you go back home.

In Summary, let your doctor decide

So, when you come in to see your GP, please don’t demand or be aggressive about wanting antibiotics.  Please let your doctor decide whether you need an antibiotic or not.  They are the only qualified ones who can tell you.   Even if you have antibiotics in the past for infections does not mean you will always need them.  In the past, doctors have given antibiotics more freely often because of patient pressure rather than there being a clinical need.   However, doctors these days are more clued up and more aware about the hazards of antibiotic resistance.  So – let the professionals make that professional decision.

And if you are given an antibiotic, always follow your doctor’s advice on when and how to use antibiotics.

Here are some real patient stories

These stories are not to scare you but to simply show you the reality of the situation.