Reading the September 1st British Medical Journal on my return from holiday I was pleased to see both an editorial and a research paper focussing on prescribing antibiotics in primary care. 

A study in Australian children showed that, 2 months after being prescribed antibiotics for a respiratory infection, they were twice as likely to have antibiotic resistant bacteria in their throats than a control group.

The editorial cautions the use of antibiotics in upper respiratory infections that will often get better without, and urges us to use antibiotics as carefully as we should oil – as a non- sustainable resource. The bacteria will always evolve ways of getting over whatever antibiotics we come up with, which is why the drug companies are working faster and faster to come up with new drugs more rapidly.

My own approach, as ever in general practice, is to look at each case individually. However, I know that I would hesitate to use antiobitcs in my own children if they had a sore throat or otitis media, unless it looked very purulent and they were very unwell. I usually give the parent an opportunity to return if the child is not improving, or a prescription to get made up in 24-48 hrs if symptoms are worsening.  If there are no signs of a chest infection (as opposed to bronchitis, which is an upper airway infection that does not need antibiotics), then antibiotics are not needed for a chesty cough, either.

Experience is key, along with education of patients and their families. One particularly useful aid to this is the patient leaflets that I give out in surgery, which come from the http://www.patient.co.uk site – do look! There is excellent information about the use of antibiotics.

Sore throats can be a bit different of course. If there is strong evidence of tonsillitis (although a study previously showed that a clinician cannot distinguish this accurately from glandular fever, a viral infection that does NOT need antibiotics), with pain, pyrexia, a pusy discharge on enlarged red tonsils, and tender enlarged cervical lymph nodes, then antibiotics are useful. However, if antibiotics are used, a further study showed that a full 10 day course of penicillin V is needed to eradicate Streptococcus from the throat. This goes against our trend in other infections to shorten the duration of a course of antibiotics. Now if only I can find those two references…

So you can see how complicated evidence based medicine is, how it is a full time job keeping up with it, and how we have to do our best to come up with a workable way forward with these things.

I am convinced of one thing since I started my healing journey – it is vitally important to let the body’s own immune system work wherever possible, and not step in with antibiotics until and unless necessary. And I was amazed when a homeopathic doctor friend of mine told me that he managed all of his own children’s otitis media with homeopathic remedies! It had never entered my head before that this would be possible. There is so much to learn in medical school that the complementary therapies fall by the wayside.

I was amazed when reading the British Medical Journal recently (28th July 2007) that other organisatios share my concerns about medications and their effects on health.

I believe that the ideal way forward is of integrated medicine – integrating the best of modern medicine, including surgery and pharmaceuticals, with a holistic approach to the person/ patient, with them addressing their own mind, body and spirit, including the use of complementary therapies.

Apparently "Pharmageddon" is the prospect of a world with the use of medicine and pharmaceuticals producing more harm than good. The following two websites are worth a look:

Social Audit

Health Action International

And there will be a conference on the topic next year.

Don’t get me wrong – there are huge benefits afforded by modern medicines – but they are not the be-all and end-all!

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