Antibiotics, revisited! - Blog 12

Wednesday, October 11, 2017 - 15:30
Dr Paul Williams
Those of you who keep up with all things CCG will no doubt have picked up that I have been elevated to the role of Chair of the CCG. I have not yet decided what to do with these blogs going forward so watch this space for developments.
Before I do talk about this month’s topic I just want to labour the point I made last month about having your flu injection if you are in an at risk group. Real flu is something I hope none of you ever experience as it is so much more than a heavy cold, you really don’t want to experience it so go and get a flu jab where you can.
This month I want to focus directly on antibiotics again.  I wrote about these back in the winter but we are entering the cough and cold season and I know from studying prescribing statistics antibiotic prescribing rises in the next few months. These drugs have transformed our lives and their over use could transform them again but this time for the worse.  Overuse of antibiotics will make them useless and that is what we want to avoid.
One of the concepts patients have which is not really a medical concept is strength of antibiotics; I often get asked when I prescribe an antibiotic, “is this a strong one doctor?” Well antibiotics have varying ranges of activity, we call it a spectrum; some are broad spectrum and others narrow. Broad spectrum drugs kill a wide range of different bacteria while narrow spectrum a much smaller number. However, what is important for you is that the antibiotic you take kills the bacteria causing your infection. Some of the newer antibiotics, and in fact we have very few new ones, the last major group that was discovered was over 20 years ago, are quite broad spectrum and the problem with these  is that they also tend to cause more side effects. For example diarrhoea; our gut is full of “friendly bacteria” and unfortunately these broad spectrum antibiotics don’t just kill the nasty bacteria but these friendly ones too. This causes an imbalance of bacteria in the gut which can cause diarrhoea, including quite bad diarrhoea like Clostridium diffcile which shuts hospital wards if it breaks out in people in hospital; there is nothing like a ward closure to plunge the whole local health system into chaos with ambulances backing up at A&E with nowhere to discharge their patients.
So you can see from this inappropriate antibiotic use can have huge ramifications completely unforeseen at the moment you ask the doctor for a prescription. Some broad spectrum antibiotics we are trying to get used less both locally and across the country are co-amoxiclav, ciprofloxacin and cefalexin; please don’t ask for one of these antibiotics because you think they are “strong”. They have their place and we, in conjunction with the other CCGs in Norfolk, produce an antibiotic formulary which advises doctors on which antibiotics to use for specific infections. The choice is evidence driven based on the most likely bacteria to be implicated in the infection; it is like using a telescopic sight on a rifle to aim for one spot on a target compared to letting fly with both barrels of a shot gun!