Tuesday, 6 March 2012

Antibiotics for everyone!

I spend a fair amount of patient contact time assessing patients, especially the young and old, who have infections. The majority are not bacterial infections and are self limiting. Some friends tease me by suggesting that all you need to do as a GP is to practice saying 'it's a virus' and buzzing for the next patient.

It's undoubtedly good medicine to not over-prescribe antibiotics. They are after all a limited resource and there's no guarantee that they will keep pace without emerging infections. But trying to discern the patients who do need antibiotics is challenging. Over prescribing risks population harm, through greater drug resistance. But under-prescribing may lead to serious illness in the individuals seen on a daily basis.

I muse on this because of a recent experience where a fit young mother who presented with tracheitis became very ill the day after I had seen her with an invasive Strep A infection. According to the Health Protection Agency web site,

Who is at risk of invasive group A streptococcal infections?

Invasive GAS infections are most common in the elderly (> 75years of age, approximately 8 cases per 100,000 population) and the very young (The most common risk factor for invasive GAS infection is having a skin lesion (a lesion is an abnormality due to disease or injury) of some kind which provides easier entry of the organism in to the body.  A small proportion of invasive GAS infections start with a respiratory tract infection.
  • Other risk factors include:
  • Injecting Drug Use
  • Alcoholism
  • Immunosuppression
  • Diabetes
  • Malignancy (cancer)
Whilst recent childbirth is a potential predisposing factor for GAS infection, it contributes only about 4% of the total invasive GAS infections

None of those were relevant to my patient. How difficult GP is.
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