Thursday, 7 January 2010

Battle lines drawn

Back from the Christmas holidays, and so it seems are a host of nasty viral illnesses. They've taken full advantage of our tendency to run ourselves into the ground during the silly season, seeing as many people as we can and giving our viral friends their very own reason to celebrate. It means that my usually peaceful waiting room has been converted into a mass of runny noses and hacking coughs. Their owners have come for antibiotics, and will feel cheated if they leave empty handed.

And so I prepare for battle. The tactics are diverse, the terrain treacherous. There are those who launch straight in with their request, standing over me with a loaded gun... (or is that my imagination?) Others remain under camouflage initially, but are so crushed by my suggestion of paracetamol that they then take up their attack. A few go for a more underhand tactic, comparing me unfavourably to my colleges; "Dr Jones always gives me antibiotics when I've asked in the past". Once or twice I have even heard a patient change their symptoms mid consultation having caught wind of my unwillingness to prescribe.

My defences are limited. Most are already bored of my 'virus versus bacteria' speech and since I have no way of proving to them that theirs is a virus, few are satisfied. Of course there's the strong argument of the need to avoid encouraging bacterial resistance but many won't see this as relevant to them or else they are so bored by my spiel by this point that they have begun to drop off. If I'm getting desperate I do occasionally throw in a few nasty sounding side effects, but those who have used antibiotics before are not swayed by this one.

The fight goes on, patient after patient, and I am tiring. I think to myself how much easier my morning could be if I just signed the prescriptions and got on with it. The temptation is huge, but unfortunately for me my irritatingly pious conscious will not allow it and so by the end of the morning I am battered and bruised, in desperate need of some R & R.

You may wonder why it is that I feel compelled to fight so hard, but there truly are plenty of reasons why we shouldn't be too liberal with antibiotics. Remember the c difficile horror stories of patients dying in their hospital beds from uncontrollable diarrhoea? Antibiotic overuse was largely responsible. It's also worth noting that no new classes of antibiotics have been discovered since the 1960's and so the ever growing problem of resistance really does pose a substantial threat.

Of course I'm being a little facetious as there are plenty of people who are fully aware of these facts and are happy to accept my explanations. Certainly there are also those who actually do need antibiotics and it's clearly always better to check if you're worried. But for those who can do without them, I will continue with my own peculiar war, confident in the knowledge that I am far more likely to become a casualty of the process than they are.


  1. Mate, I feel your pain. Some people even come to paediatric A+E with their kid, as "My GP won't give him antibiotics".
    I always tell them the GP was right. It's a hard battle to fight though. Keep up the good work.

    Dr. Thunder

  2. Hi PP,

    Just found your blog and, trying not to gush, I think it's very well written and a joy to read. I hope you keep it up.

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  4. Thanks so much for your comments. I'm hoping that these sub-zero temperatures might play to our favour this year and wipe out some of the nasties - although I fear that might be an urban myth...

  5. One problem is that it is not in the interest of drug companies to develop new antibiotics - they cost a great deal of time and money to develop, and the rewards for doing so are less then for developing a drug for say type 2 diabetes, asthma or for a chronic disease where the patients will be taking them constantly

    Thanks to you (and others like you) though pondering practitioner there is a good chance that when i graduate (if) as a doctor that some of the antibiotics floating around will be still be useful

  6. Not quite true to say there've been no new antibiotics discovered since the 1960's - there are three recently discovered ones: cyclic lipopetides, glycylcylcines and oxazolidinones. It's fair enough to say that we're in trouble as far as attempts to find more are concerned though (especially as resistance to all the above has already been seen).
    Like you say I guess the onus now has to be on using what we have as well as possible.
    I'll be interested to see if anything much comes of phage therapy, at least.
    Whilst Fuddled Medic is right about drugs companies not having much incentive to research antibiotics, credit where credit's due for releasing their data on bacterial minimal genomes, since at least that gives a set of targets for small biotechs and academia to use; they can look for potential inhibitors as drug candidates for a relatively small amount of money, then having identified some hopefully it'll be cost-effective for big pharma to try to take them further.