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There’s always
the temptation when you get fed up with that troublesome cough or bout
of sinusitis to go and ask the doctor if they can give you anything for
it.
Often that ‘anything’ will be antibiotics. GPs write around 35
million prescriptions for these every year in England – an increase of
30 per cent since 2000, according to NHS figures.Â
To some,
antibiotics are regarded as a cure-all. In fact, they work only for
bacterial infections – so if that sore throat is the result of a virus,
they won’t do any good.
o some, antibiotics are regarded as a cure-all. In fact, they work only for bacterial infections
Yet a recent study revealed that almost half
of GPs admit prescribing antibiotics even when they know they won’t help
– and 90 per cent said they felt pressure from patients to do so.
Yet
giving antibiotics to those who don’t really need them is partly to
blame for the rise in antibiotic-resistant super bugs, according to the
Chief Medical Officer, Dame Sally Davies.
‘If a doctor says
antibiotics are not appropriate for an illness, we should all listen and
not pressurise them into giving us unnecessary drugs,’ she said last
month. ‘Resistance to antibiotics is a real threat.’
Already 5,000
people die from antibiotic-resistant infections every year in England
and common antibiotics are becoming increasingly ineffective.
So
when do you really need antibiotics and when would you be better off
without them? Here Dr Louise Selby, an NHS GP for 15 years and partner
of the Guildford Private General Practice, explains.
Sore throats are caused by viruses, not bacteria
SORE THROAT
This is one of the most common reasons people come and ask for antibiotics.
WHEN YOU DON’T NEED ANTIBIOTICS: In the vast majority of cases, sore throats are caused by viruses, not bacteria.
Antibiotics
work by killing or disabling bacteria – they have no effect on viruses.
You are far better off taking something to ease the discomfort such as
an over-the-counter painkiller, for example paracetamol or ibuprofen,
and resting, to help your immune system beat the virus.
WHEN YOU DO:
Having a high temperature coupled with white spots on the tonsils can
indicate a bacterial infection, although viruses can also lead to this
symptom. One way to tell the difference is that viruses tend to cause
other symptoms, such as a runny nose, sneezing and cough. A bacterial
infection is often much more localised and you may just get the throat
symptoms.
In severe cases, where someone has enlarged glands in the
neck combined with high temperature over 38.5c, and they had already had
symptoms for more than 24 to 48 hours, I may prescribe a course of an
antibiotic such as penicillin.Â
CHEST INFECTIONS
A chest
infection, which affects the lungs, is different from a normal cough,
which is usually due to inflammation in the upper airways and
congestion. They are more common in young children and the elderly, as
well as those who smoke or have a pre-existing respiratory condition
such as asthma.
WHEN YOU DON’T NEED ANTIBIOTICS: Bronchitis is
usually caused by a virus so only rarely will antibiotics help. It
usually gets better on its own, although you can ease the symptoms with
aspirin, paracetamol and ibuprofen.
If you have been coughing and
unwell for a short period of time – up to two weeks – and you are
otherwise fit and healthy, you probably don’t need antibiotics.
However,
do see a doctor if it lasts for more than three weeks. You can get a
secondary bacterial infection from a chest infection so watch for other
symptoms such as high fever and wheezing.
WHEN YOU DO: Symptoms such
as a high temperature of more than 38.5c, shortness of breath, headache
and coughing up brown, foul-tasting phlegm, can be a symptom of
pneumonia.
This can follow a chest infection especially in the
elderly. Unlike bronchitis, pneumonia can be caused by bacteria and
antibiotics are often necessary. If you cough up blood or have a
persistent cough for more than three weeks, you must see a doctor.
Bronchitis is usually caused by a virus so only rarely will antibiotics help
SINUSITIS
This
can be very uncomfortable, causing pain in the face and a blocked-up
feeling. It is caused by inflammation of the lining of the air spaces in
the nose.
WHEN YOU DON’T NEED ANTIBIOTICS: Most sinusitis is caused
by a virus, so antibiotics won’t help. Steam inhalation – bending your
head over a bowl of steaming water with a towel over your head – can
relieve pressure behind the eyes as it moistens and loosens the
secretions, making them easier to clear through the nose.
Over-the-counter
painkillers can help and decongestants can relieve the bunged-up
feeling temporarily. Sinusitis typically lasts twice as long as a cold –
more than two weeks in many cases – so don’t expect it to go away
quickly.
WHEN YOU DO: If your symptoms have not improved at all after
a week, or you have regular bouts of sinusitis – several times a year –
antibiotics may be appropriate. That’s because about a third of people
with sinusitis will develop a secondary bacterial infection in the
lining of their sinuses that requires treatment with antibiotics.
EYE INFECTIONS
The
irritation, pain and discharge of an eye infection can be caused by
bacteria, viruses or fungi. It can be difficult to distinguish between
them.
WHEN YOU DON’T NEED ANTIBIOTICS: Mild infections – where there
is some redness and minimal discomfort – can be treated with
over-the-counter, antibacterial remedies such as Brolene Eye Drops and
GoldenEye which both contain propamidine isetionate.
Rather than killing the bacteria, this slows their growth, allowing your body to fight off the infection.
WHEN
YOU DO: When the eyes are very sore with a discharge, and may be stuck
together with crusting, this can be a sign of bacterial conjunctivitis
and may mean antibiotic eye drops are necessary.
I would usually prescribe these for five days to patients, including children from the age of one.
If you have regular bouts of sinusitis – several times a year – antibiotics may be appropriate
EAR INFECTIONS
CHILDREN
are most prone to ear infections because the narrow air passages in the
inner ear can easily become blocked by mucus. The infection usually
targets the middle ear, the otitis media, causing a build-up of fluid,
which leads to pain, dizziness and reduced hearing.
WHEN YOU DON’T
NEED ANTIBIOTICS: A middle ear infection is usually caused by a virus
and will resolve on its own, typically within three days. Paracetamol or
ibuprofen can help with pain or fever.
WHEN YOU DO: In adults or
children, if the symptoms are severe – including high fever of over
38.5c and vomiting, and don’t settle within two to three days, or if
there is pus oozing out of the ear, I usually prescribe a course of the
antibiotic amoxicillin.
I am more likely to prescribe antibiotics if a
child is under two, as ear infections are more likely to result in
complications for this age group, such as a burst eardrum.
URINARY TRACT INFECTION
These
occur when bacteria invade the tract which carries urine from the
kidneys to the bladder and down the urethra. They can make you want to
urinate more than normal and can make it painful.
UTIs are 50 times
more common in women than men because women have shorter urethras,
making it easier for bacteria to invade the urinary tract.
WHEN YOU
DON’T NEED ANTIBIOTICS: Mild symptoms, including a slight burning
sensation when passing urine, and needing to going to the loo more
often, can be eased by drinking plenty of water and 250-500ml of
cranberry juice daily.
The juice stops bacteria sticking to the
walls of the bladder. Cystopurin, an over-the-counter sachet, inhibits
growth of bad bacteria.
If you have a recurring UTI, it is often
worth trying to address the underlying cause: it could result from
simply not drinking enough water or using too much soap when you wash
intimate areas.
WHEN YOU DO: If you have loin pain in the back or in
your sides and a temperature, it can indicate that the infection has
spread to the kidneys and antibiotics are then necessary. Antibiotic
treatment is also a mainstay for the treatment of severe cystitis –
where there is intense burning during urination.
SKIN INFECTIONS
THE
most common infectious skin condition seen by doctors is impetigo,
which causes red, crusty lesions and often starts on the face and
spreads.
WHEN YOU DON’T NEED ANTIBIOTICS: Some children get impetigo
regularly and antibiotics cannot clear the infection completely because
the bacteria can colonise in the nose and stay dormant in towels, sheets
and door handles.
A new hydrogen peroxide cream Crystadide has been
shown to be effective in these cases because it basically acts as a
steriliser.
Antibiotics won’t work on infections such as ringworm, which can be treated with antifungal cream.
WHEN
YOU DO: I usually prescribe antibiotics for impetigo. If it was just
one spot, I might use an antibiotic cream such as Fucidin, but oral
antibiotics are usually needed as the bacterial infection can be carried
throughout the skin.
Also, if the skin – particularly on the legs –
becomes suddenly hot, red and inflamed it can be a sign of cellulitis, a
deep skin infection common among older people that does need
antibiotics.
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