Antibiotic treatment failure in primary careBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5970 (Published 02 October 2014) Cite this as: BMJ 2014;349:g5970
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I read this article with some amusement as the first question I asked myself is what were the criteria for failure? Only to read that it was switching to an alternative antibiotic within 30 days which was considered failure and thus bacterial resistance.
However in my experience in secondary care and to cite two examples, most notably dermatology where patients are referred for not only bilateral cellulitis but cellulitis that has been resistant to their GP's 6 or so courses of back to back antibiotics only to tell them they have a condition called lipodermatosclerosis which will never respond to antibiotics.
It also becomes apparent having done acute and emergency medicine where the patient has been started on antibiotics via a telephone consultation with their GP, more so during out of hours for the usual suspect of a UTI most often in the elderly in cares homes with no urinalysis or MSU, and are referred or self present with something not in the least bit associated with their original diagnosis after the second or third course of antibiotics fail to work.
It is obvious the prescriber is at fault and not the antibiotics for the failure but despite best efforts, patients still come to expect antibiotics and not least primary care feel they are doing something by prescribing them even if they are not required.
Thankfully the editorial agrees that inappropriate prescribing is to blame; my question is why are they being prescribed inappropriately in the first place.
Could it be blamed on the short duration and lack of experience for current GP training?
Competing interests: No competing interests