London - There’s always the temptation when you get fed up with that troublesome cough or bout of sinusitis to go and ask the doctor if they can give you anything for it.
Often that ‘anything’ will be antibiotics. GPs write around 35 million prescriptions for these every year in England - an increase of 30 percent since 2000, according to NHS figures.
To some, antibiotics are regarded as a cure-all. In fact, they work only for bacterial infections - so if that sore throat is the result of a virus, they won’t do any good.
Yet a recent study revealed that almost half of GPs admit prescribing antibiotics even when they know they won’t help - and 90 percent said they felt pressure from patients to do so.
Yet giving antibiotics to those who don’t really need them is partly to blame for the rise in antibiotic-resistant super bugs, according to the Chief Medical Officer, Dame Sally Davies.
“If a doctor says antibiotics are not appropriate for an illness, we should all listen and not pressurise them into giving us unnecessary drugs,” she said last month. “Resistance to antibiotics is a real threat.”
Already 5 000 people die from antibiotic-resistant infections every year in England and common antibiotics are becoming increasingly ineffective.
So when do you really need antibiotics and when would you be better off without them? Here Dr Louise Selby, an NHS GP for 15 years and partner of the Guildford Private General Practice, explains.
SORE THROAT
This is one of the most common reasons people come and ask for antibiotics.
WHEN YOU DON’T NEED ANTIBIOTICS: In the vast majority of cases, sore throats are caused by viruses, not bacteria.
Antibiotics work by killing or disabling bacteria - they have no effect on viruses. You are far better off taking something to ease the discomfort such as an over-the-counter painkiller, for example paracetamol or ibuprofen, and resting, to help your immune system beat the virus.
WHEN YOU DO: Having a high temperature coupled with white spots on the tonsils can indicate a bacterial infection, although viruses can also lead to this symptom. One way to tell the difference is that viruses tend to cause other symptoms, such as a runny nose, sneezing and cough. A bacterial infection is often much more localised and you may just get the throat symptoms.
In severe cases, where someone has enlarged glands in the neck combined with high temperature over 38.5c, and they had already had symptoms for more than 24 to 48 hours, I may prescribe a course of an antibiotic such as penicillin.
CHEST INFECTIONS
A chest infection, which affects the lungs, is different from a normal cough, which is usually due to inflammation in the upper airways and congestion. They are more common in young children and the elderly, as well as those who smoke or have a pre-existing respiratory condition such as asthma.
WHEN YOU DON’T NEED ANTIBIOTICS: Bronchitis is usually caused by a virus so only rarely will antibiotics help. It usually gets better on its own, although you can ease the symptoms with aspirin, paracetamol and ibuprofen.
If you have been coughing and unwell for a short period of time - up to two weeks - and you are otherwise fit and healthy, you probably don’t need antibiotics.
However, do see a doctor if it lasts for more than three weeks. You can get a secondary bacterial infection from a chest infection so watch for other symptoms such as high fever and wheezing.
WHEN YOU DO: Symptoms such as a high temperature of more than 38.5c, shortness of breath, headache and coughing up brown, foul-tasting phlegm, can be a symptom of pneumonia.
This can follow a chest infection especially in the elderly. Unlike bronchitis, pneumonia can be caused by bacteria and antibiotics are often necessary. If you cough up blood or have a persistent cough for more than three weeks, you must see a doctor.
SINUSITIS
This can be very uncomfortable, causing pain in the face and a blocked-up feeling. It is caused by inflammation of the lining of the air spaces in the nose.
WHEN YOU DON’T NEED ANTIBIOTICS: Most sinusitis is caused by a virus, so antibiotics won’t help. Steam inhalation - bending your head over a bowl of steaming water with a towel over your head - can relieve pressure behind the eyes as it moistens and loosens the secretions, making them easier to clear through the nose.
Over-the-counter painkillers can help and decongestants can relieve the bunged-up feeling temporarily. Sinusitis typically lasts twice as long as a cold - more than two weeks in many cases - so don’t expect it to go away quickly.
WHEN YOU DO: If your symptoms have not improved at all after a week, or you have regular bouts of sinusitis - several times a year - antibiotics may be appropriate. That’s because about a third of people with sinusitis will develop a secondary bacterial infection in the lining of their sinuses that requires treatment with antibiotics.
EYE INFECTIONS
The irritation, pain and discharge of an eye infection can be caused by bacteria, viruses or fungi. It can be difficult to distinguish between them.
WHEN YOU DON’T NEED ANTIBIOTICS: Mild infections - where there is some redness and minimal discomfort - can be treated with over-the-counter, antibacterial remedies such as Brolene Eye Drops and GoldenEye which both contain propamidine isetionate.
Rather than killing the bacteria, this slows their growth, allowing your body to fight off the infection.
WHEN YOU DO: When the eyes are very sore with a discharge, and may be stuck together with crusting, this can be a sign of bacterial conjunctivitis and may mean antibiotic eye drops are necessary.
I would usually prescribe these for five days to patients, including children from the age of one.
EAR INFECTIONS
Children are most prone to ear infections because the narrow air passages in the inner ear can easily become blocked by mucus. The infection usually targets the middle ear, the otitis media, causing a build-up of fluid, which leads to pain, dizziness and reduced hearing.
WHEN YOU DON’T NEED ANTIBIOTICS: A middle ear infection is usually caused by a virus and will resolve on its own, typically within three days. Paracetamol or ibuprofen can help with pain or fever.
WHEN YOU DO: In adults or children, if the symptoms are severe - including high fever of over 38.5c and vomiting, and don’t settle within two to three days, or if there is pus oozing out of the ear, I usually prescribe a course of the antibiotic amoxicillin.
I am more likely to prescribe antibiotics if a child is under two, as ear infections are more likely to result in complications for this age group, such as a burst eardrum.
URINARY TRACT INFECTION
These occur when bacteria invade the tract which carries urine from the kidneys to the bladder and down the urethra. They can make you want to urinate more than normal and can make it painful.
UTIs are 50 times more common in women than men because women have shorter urethras, making it easier for bacteria to invade the urinary tract.
WHEN YOU DON’T NEED ANTIBIOTICS: Mild symptoms, including a slight burning sensation when passing urine, and needing to going to the loo more often, can be eased by drinking plenty of water and 250-500ml of cranberry juice daily.
The juice stops bacteria sticking to the walls of the bladder. Cystopurin, an over-the-counter sachet, inhibits growth of bad bacteria.
If you have a recurring UTI, it is often worth trying to address the underlying cause: it could result from simply not drinking enough water or using too much soap when you wash intimate areas.
WHEN YOU DO: If you have loin pain in the back or in your sides and a temperature, it can indicate that the infection has spread to the kidneys and antibiotics are then necessary. Antibiotic treatment is also a mainstay for the treatment of severe cystitis - where there is intense burning during urination.
SKIN INFECTIONS
The most common infectious skin condition seen by doctors is impetigo, which causes red, crusty lesions and often starts on the face and spreads.
WHEN YOU DON’T NEED ANTIBIOTICS: Some children get impetigo regularly and antibiotics cannot clear the infection completely because the bacteria can colonise in the nose and stay dormant in towels, sheets and door handles.
A new hydrogen peroxide cream Crystadide has been shown to be effective in these cases because it basically acts as a steriliser.
Antibiotics won’t work on infections such as ringworm, which can be treated with antifungal cream.
WHEN YOU DO: I usually prescribe antibiotics for impetigo. If it was just one spot, I might use an antibiotic cream such as Fucidin, but oral antibiotics are usually needed as the bacterial infection can be carried throughout the skin.
Also, if the skin - particularly on the legs - becomes suddenly hot, red and inflamed it can be a sign of cellulitis, a deep skin infection common among older people that does need antibiotics. - Daily Mail