Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Goodbye virus?
- Alistair J Howitt (25 July 2008)
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Some other points re antibiotics
- David Simpson (27 July 2008)
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Antibiotics and "Chest infections"
- Rod A Storring (28 July 2008)
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Alistair J Howitt, GP Warders Medical Centre, East Street, Tonbridge, Kent, TN9 1LA
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In 1996 Kai (1) explored the difficulties of parents living in a disadvantaged community of coping with acute illness in their children. They found that doctor’s explanations of the illness and its treatment which involved use of the concept of a ‘virus’ unhelpful and unsatisfactory. They felt that the use of antibiotics should not relate to the cause of the illness, rather its severity. In doing so they anticipated the recommendations of the NICE guidelines for respiratory tract infections in primary care by twelve years (2). The word ‘virus’ does not feature at all in the guideline’s 121 pages, ‘viral’ appears only five times peripherally. Given the lack of evidence of that we can use these words or concepts in a useful way, either to determine what is the best treatment or to explain the illness to the patient is it now time to drop the virus from our consulting repertoire for these conditions? 1. Kai J. (1996). Parents' difficulties and information needs in coping with acute illness in preschool children: a qualitative study. BMJ ;313:987-990 2. BMJ 2008;337:a437 Competing interests: None declared |
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David Simpson, Gp principal Hamilton, ML3 8AA
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It is all very well offering guidance to General Practitioners and others regarding this, but what about the amount of antibiotics dished out by vets?. Or the fact that pharmacists can now dispense chloramphenicol for self limiting eye infections without need of bothering the doctor. In the end of the day with the British government rubbishing GP's through the media, patients are less trusting of Doctors. I try my best not to prescribe antibiotics but on occassions it can be extermely difficult to resist patient expectations. Delayed presciprtions are not ideal either as the patient can pick up a prescription for an antibiotic, not use it for the pesent illness and then uses it for the next illness, or simply gives it a friend or Granny with another self limiting illness as they now have a stash! Competing interests: None declared |
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Rod A Storring, Community Consultant Chest Physician Barking and Dagenham PCT
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The Nice guidelines on the treament of "chest infections"do not address adequately these patients' symptoms and the need for the anti- asthma treatment that will benefit many of them.Furthemore,because of continuing symptoms,they will continue to pressurise for antibiotics given that they have been told they have a "chest infection"but have been given no treatment for the resulting symptoms. May I suggest that the term "chest infection" is unhelpful and misleading and it is more useful to stick to symptoms.Therefore cough,chest tightness,wheeze,shortness of breath,light green sputum do not warrant antibiotics and often respond to anti-asthma treatment. Again,fever,once the acute viral infection has passed,being unwell,anorexia,require an antibiotic. What do you call these two very different illnesses?What about "viral induced chestyness" for the first and "query pneumonia" the second.Some patients,such as those with COPD,with viral induced chestyness will ofcourse also need antibiotics. Competing interests: None declared |
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