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EDITORIALS: Paul Little Delayed prescribing of antibiotics for upper respiratory tract infection BMJ 2005; 331: 301-302 [Full text]

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Resistance and Loss of control

Gary Parkes   (7 August 2005)

Patient behaviour influences antibiotic intake.

Vaishali M Verma, email vermadr@hotmail.com   (7 August 2005)

Just say no.

Richard Watson   (10 August 2005)

Resistance and Loss of control 7 August 2005
Gary Parkes, GP Hoddesdon, Herts,UK Send response to journal: Re: Resistance and Loss of control	Sir, This is a useful editorial to summarise and confirm what may now be regarded as 'historical good practice'. There are two problems that come to mind. First, delayed prescribing used to be under the control of a GP or a GP practice with a fair degree of cooperation and continuity. These days if I decline to give antibiotics for little Jonny's sore throat the patient can get a second third and fourth 'opinion' by going to - the 'walk-in' centre, the A&E or the Out of hours centre where the trend seems to be to issue antibiotics on demand. Prescribing antibiotics has gone up dramatically since most GPs opted out of 24 hour care. The 1997 research is now out of date to cope with this new improved Labour access to 'care'where patients shop around till they get what they want. Secondly I am yet to be convinced by the relationship of antibiotic resistance and GP prescribing. If this is true why can I still treat otitis media with amoxicillin or strep sore throats with Penicillin V just like 20 years ago. Buckets of antibiotics used for growth promotion in food production and the use of the same antibiotics in vetinary work, as well as the use of every new fancy antibiotic for 'prophylaxis' in hospital surgery seem far more likely culprits. Unfortunately research evidence becomes out of date as soon as the goal posts change which often happen as a result of some non-medical government minister's new idea. Competing interests: Low prescribing practice
Patient behaviour influences antibiotic intake. 7 August 2005
Vaishali M Verma, General Medical Practitioner Delhi, INdia, email vermadr@hotmail.com Send response to journal: Re: Patient behaviour influences antibiotic intake.	Dear Editor, There appears to be shift in patient habits around the world.In developing countries, the mother would bring the child to a doctor, after maybe a week, if the signs and symptoms do not disappear on their own, as medical care is expensive and therfore sought after at a later date, by when, either the infection has disappeared or manifested in a severe form with fever, vomiting etc. kind regards, Dr.V.M.Verma Competing interests: None declared
Just say no. 10 August 2005
Richard Watson, General Practitioner 11 Craigallian Avenue, Cambuslang, Glasgow, G72 8DQ Send response to journal: Re: Just say no.	You advise antibiotics for all coughs after 10-14 days. This contradicts the SIGN guideline(1,)the Prodigy guidance (2) and patient information leaflet, and my personal experience. It is common for a cough in a previously well adult to last for 3 weeks or so and surely we do not all need an antibiotic. If they get an antibiotic after 2 weeks, as you advise, then they are likely to improve in a week, as they would have done without it. richard.watson920@ntlworld.com References 1. SIGN (2002) Community management of lower respiratory tract infection in adults. Report no. 59. Scottish Intercollegiate Guidelines Network. www.sign.ac.uk 2. http://www.prodigy.nhs.uk/guidance.asp?gt=Chest%20infections Competing interests: Too much work to do and don't wish people with minor cough for 10 days to bother me.