A novel initiative which needs to be properly thought through
The concept of using financial carrots for health promotion is not new. The menace of antibiotic resistance is here with us now and is likely to get worse over time. The new initiative of using financial rewards for improvement in the current situation therefore merits discussion.
There is strong evidence of antibiotic resistance with over use and broad spectrum antibiotics impart particular concern as in addition to resistance there is the issue about C. Diff. diarrhoea. On top, many of the supposed infections may not be bacterial either. On the backdrop of this, one has to consider the anxiety among health professionals about underduagnosing serious bacterial infections. Missing meningitis would be fatal. Missing serious sepsis or severe pneumonia would be similarly catastrophic.
There is an unmet need for more clinical training in diagnosing serious bacterial infections. In UK there appears timely focus on early diagnosis of sepsis, but bottom line remains that often in these situations be it in primary or secondary care, the onus is on clinicians to take a call based on clinical judgement. Further training in these areas would most likely improve confidence in making the right decision. Medicine is not always black and white and a position to err on the side of caution is entirely understandable. There needs to be more support for the clinician making the call at the front end, which may mean easy availability of imaging and blood tests. Some of these may include Chest Xray at primary care, easy availability of pro calcitonin, lactates and/or CT scans in the hospitals and an established antibiotic steering group to publish guidelines. Even if antibiotics cannot be avoided entirely using narrow spectrums like penicillin or even judicious use of amino glycosides may help us protect the silver bullets of penems and such drugs in the near future. At the same time we need to make a global effort to tackle the elephant in the room.
There is sadly a view in some quarters that we may already have lost the battle. That, ultimately the tiny microbes will win over. However, with judicious use of current antibiotics we gain vital time to develop newer molecules. We may have lost the battle, but the war has just begun.
Rapid Response:
A novel initiative which needs to be properly thought through
The concept of using financial carrots for health promotion is not new. The menace of antibiotic resistance is here with us now and is likely to get worse over time. The new initiative of using financial rewards for improvement in the current situation therefore merits discussion.
There is strong evidence of antibiotic resistance with over use and broad spectrum antibiotics impart particular concern as in addition to resistance there is the issue about C. Diff. diarrhoea. On top, many of the supposed infections may not be bacterial either. On the backdrop of this, one has to consider the anxiety among health professionals about underduagnosing serious bacterial infections. Missing meningitis would be fatal. Missing serious sepsis or severe pneumonia would be similarly catastrophic.
There is an unmet need for more clinical training in diagnosing serious bacterial infections. In UK there appears timely focus on early diagnosis of sepsis, but bottom line remains that often in these situations be it in primary or secondary care, the onus is on clinicians to take a call based on clinical judgement. Further training in these areas would most likely improve confidence in making the right decision. Medicine is not always black and white and a position to err on the side of caution is entirely understandable. There needs to be more support for the clinician making the call at the front end, which may mean easy availability of imaging and blood tests. Some of these may include Chest Xray at primary care, easy availability of pro calcitonin, lactates and/or CT scans in the hospitals and an established antibiotic steering group to publish guidelines. Even if antibiotics cannot be avoided entirely using narrow spectrums like penicillin or even judicious use of amino glycosides may help us protect the silver bullets of penems and such drugs in the near future. At the same time we need to make a global effort to tackle the elephant in the room.
There is sadly a view in some quarters that we may already have lost the battle. That, ultimately the tiny microbes will win over. However, with judicious use of current antibiotics we gain vital time to develop newer molecules. We may have lost the battle, but the war has just begun.
Competing interests: No competing interests