My last blog ‘More to pharmacies than meet the eye’ highlighted the increased services pharmacies now provide and that they are an excellent first ‘port of call’ for advice and treatment options if you are feeling unwell with a minor illness. At the same time as writing this, another article in the BBC health news caught my attention that somewhat relates to this blog- that of the growing threat of antibiotic resistant infections. http://www.bbc.co.uk/news/health-25654112.

England’s Chief Medical Officer Dame Sally Davies described the growing resistance to antibiotics as a ‘ticking time bomb’ and said ‘the danger ranked alongside terrorism on the list of national threats’. It has been described as a ‘global issue,’ and, rather alarmingly, a threat to mankind with ‘the prospect of a return to the pre-antibiotic era.’ As a nurse and prescriber, I find it extremely hard to imagine a time when we no longer have life- saving treatments available to us that we have relied upon for so many years. Most of us have been born into a world containing antibiotics. Penicillin went into widespread use in the 1950s, but infectious agents are older than humanity and continually evolving. Two bacterial infections that illustrate the problem are:

1. Multi-drug resistant (MDR) tuberculosis (TB). Of note, TB is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent. In 2012, 8.6 million people fell ill with TB and 1.3 million died from TB (WHO).

2. Infections from enterobacteriaceae e.g. E. coli- which can cause urinary tract infections (UTIs), cystitis and kidney infections. UTIs are common in general practice, accounting for 1-3% of all consultations. Almost half of all women report at least one UTI sometime during their lifetime, and after an initial UTI, 20% to 30% of women experience a recurrence. This is a common infection we see in female student patients at SHS.

We are also seeing alarming increases worldwide in gonorrhoea infections; this is again becoming extremely difficult to treat due to resistance to antibiotics.

So what is causing this problem?

Inappropriate use and prescribing of antibiotics is causing the development of resistance.

Inappropriate use includes:

  • not completing a course of antibiotics as prescribed
  • skipping doses of antibiotics
  • not taking antibiotics at regular intervals
  • saving some for later

Inappropriate prescribing includes:

  • unnecessary prescription of antibiotics
  • unsuitable use of broad-spectrum antibiotics
  • wrong selection of antibiotics and inappropriate duration or dose of antibiotics

Make antibiotic prescribing a priority in primary care by:

  • developing an antibiotic stewardship tool for prescribers

Within Bristol, we have ‘antimicrobial prescribing guidelines’ for the community as a tool to refer to and follow, ‘to provide a simple, best clinical judgment approach to the treatment of common infections; to promote the safe, effective and economic use of antibiotics and to minimise the emergence of bacterial resistance in the community.’

Frequently, patients who I see in my appointments ask for ‘antibiotics’ for their sore throat, colds and other minor illnesses. The majority of these illnesses we see in general practice are caused by viruses. Antibiotics will only treat bacterial infections, not viruses, so rest assured that careful clinical reasoning lies behind a decision not to prescribe antibiotics. If you are prescribed antibiotics, please take note of the ‘appropriate use’ points as above.

Remember the pharmacy is there for advice, treatment and referral if you do develop a minor illness. The patient.co.uk website is also an excellent source of information for patients and health care professionals alike http://www.patient.co.uk/.