Source: http://www.healthoho.com/simple-steps-to-fight-against-high-fever/
You have a sore throat and your nose is running like a KL marathon. You drag yourself to your nearby GP and after seeing the doctor, you open the white plastic bag to find that the friendly doctor that attended to you forgot to give you any antibiotics. Or did he? Before you throw a tantrum and barge through his clinic demanding your magic cure for all illness, pause to reflect. There must be a reason that antibiotics were omitted from your treatment plan.
Antibiotics are a type of medication that inhibit the growth or destroy microorganisms. Antibiotics are commonly used to treat infections both in hospitals and in the community. Doctors are required to perform a thorough clinical assessment (history, physical examination, relevant investigations) to ascertain the underlying disease process in each patient that presents to them. If the cause of the symptoms is an infection, the doctor will predict the pathogens (infective organism) associated with the infection and select the most suitable antibiotic that will target the likely organisms.
Antibiotics are effective when used against bacterial infections, certain fungal infections and some types of parasitic infections. Antibiotics do not work against viruses. Antibiotics should not be prescribed when bacterial infections are unlikely, such as for common cold and most coughs because taking an antibiotic when you have a viral infection will not treat the underlying cause or relieve the symptoms; it will however contribute to antibiotic resistance.
The consensus that antibiotic use or misuse is a major driving force for antibiotic resistance is now an established and recognized fact. Therefore all doctors and patients should be aware of several factors that should be considered before antibiotics are prescribed.
Source: http://www.nsf.gov/outage.html
Indication: Are antibiotics indicated?
There should be evidence or strong suspicion that the aetiological (causative) agent is microbial demonstrated by signs and symptoms of infection and positive laboratory results.
Common organisms
The type of antibiotic given is based on the doctor’s knowledge of the common organisms that cause that particular illness. Knowing the common organism also means knowing its susceptibility to particular antibiotics.
Antibiotic spectrum
Antibiotic spectrum is the range of organisms that the antibiotic treats. Deciding the spectrum of antibiotics depend on many factors including the severity of illness, the most likely microorganisms involved and whether or not the patient has other co-morbid factors (other illnesses such as diabetes mellitus, hypertension etc.)
Cost-effectiveness
Choosing the wrong antibiotic or prescribing unnecessary antibiotics will result in increased health care costs (cost of the antibiotic and overall costs due to the treatment failures and related adverse events associated with inappropriate use). Whereas using an optimal course of antibiotics when necessary has not only clinical advantages but also economic, since the patient will return to their normal daily activities including work, much faster.
Source: hhttp://www.theguardian.com/science/2011/apr/07/antibiotic-resistance-bacteria
If antibiotics are used for illnesses that they are not designed to treat, for example colds, flu or other viral infections; they become less effective against the bacteria they are intended to treat. Another contributing factor towards the problem of antibiotic resistance are patients who do not take antibiotics according to the correct dosage and duration.
Taking an antibiotic for only a few days, instead of finishing the full course, the antibiotic may kill some, but not all, of the bacteria. The surviving bacteria become more resistant. These resistant bacteria can then be spread to other members of the community. When bacteria become resistant to first line treatments, the risk of complications and death is increased. The failure of first line antibiotics also means that doctors have to use 2nd or 3rd line antibiotics. These medications may be more expensive and are often associated with more-serious side effects.
So the next time you have the sniffles, please keep in mind that knowing when to prescribe antibiotics is an essential skill doctors must acquire to ensure you receive the best medical care. Antibiotics should only be prescribed when necessary and as a patient, having some knowledge of the indications and importance of proper antibiotic use is important in helping in the fight against antibiotic misuse and resistance.
Dr. Hidayatul Radziah Ismawi is the Chief Editor of The Malaysian Medical Gazette. She will be pursuing her PhD in Pharmacology early next year and is currently a medical lecturer at a local university. Read more about her at The Team page.
References
- National Antibiotic Guidelines 2008
- Facts about antibiotic resistance. Centers for Disease Control and Prevention
- http://www.cdc.gov/getsmart/antibiotic-use/fast-facts.html
- Antibiotics: Misuse puts you and others at risk (Mayo Clinic)
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]
Thank you very much for this wonderful article doctor. Well done. As a medical doctor myself I’ve come across with lots of patients including a very recent case whereby a rather well educated patient demanded for an antibiotic prescription for his symptoms which was clearly an allergic condition. Despite adequate explanation, his deluded belief that antibiotic is the cure had even caused an unpleasant patient to doctor conversation. More & more patients nowadays are unfortunately wrongly diagnosing themselves & feel it’s their right to choose their own preferred treatment…. which is actually more often than not, a wrong treatment. I hope everybody could kindly share this beautiful article to help educate our fellow friends.
Thank you Dr, it is our hope that with the current trend of patients being more invested in their management, that they will also be interested in the facts and reasoning behind our treatment choices. The Malaysian Medical Gazette hopes to tap into the enthusiasm that patients today have and allow them access to sound medical information. Hopefully, instead of being a tug of war, we will all be pulling in the same direction together 🙂
how about patients who refuse for antibiotics.. i had problems to get through them about the needs for antibiotic before it get worse but then who knows in future if they just get better ot get worse…
Thank you for your question Dr. Unfortunately, we do face patients who refuse medication even when it is clearly indicated. The root of the problem is still the same as those who ask for unnecessary medication, namely lack of knowledge, misinformation or other reasons (cultural, bad previous experience, mistrust of doctors/medicine). It is important to firstly identify the reason for refusal and address the issue appropriately. Secondly, no matter what the patient’s reasons are, it should be acknowledged and not simply brushed aside. For example, if the reason for refusal is due to misinformation (the patient believes that the antibiotic will do more harm than good), then the doctor should present the facts in simple, easy to understand words, in a confident and reassuring manner. Hopefully, by focusing on patient education and maintaining a healthy doctor-patient relationship, we can minimise the number of such cases.