Dr. Helen Hynes is a lecturer in Clinical Medicine at University College Cork and has worked both in Emergency Medicine and as a GP. Misprescription by doctors has been identified as a significant contributor to antibiotic resistance, so Lablinn interviewed Helen to get an insight into the GP's point of view.
A significant amount of antibiotics are mis-prescribed (at least 30% in the US, according to the CDC). What do you think causes that, apart from limitations of diagnostics? Could anything change in medical school/practice to help?
I think there are a number of reasons for this. Firstly, it would be preferable to have diagnostic techniques available to ensure that an antibiotic is warranted, and that the correct antibiotic is being prescribed, but given limitations in facilities and the costs involved, this is not possible in many cases.
Secondly, patient education would help. Some patients still expect an antibiotic when they present to the doctor with an upper respiratory tract infection, sore throat etc. Better health education in schools would help, and possibly media based public education initiatives.
Medical students are taught how and when to prescribe antibiotics. They also receive communication skills training, but If I could think of 1 thing that might help, it would be to ensure that all medical students are taught how to deal with confrontation and difficult consultations so that they would be better able to refuse an inappropriate request for a prescription. If doctors were less busy and had more time to explain their reasoning for prescribing / not prescribing to patients, that would also help, but in the current context, many general practices are understaffed, and GPs are very pressed for time.
What do you think should be top priority in tackling antibiotic resistance and why? Educating the public, courses for doctors, interventions in the agricultural industry?
I think the joint top priorities should be changes in agriculture and educating the public. The use of antibiotics in agriculture to promote animal growth and to prevent infection (unless for specific case) should be discouraged.
I think doctors are well aware of antibiotic resistance issues. If antibiotics get prescribed inappropriately, I think it is because of a breakdown in communication between doctor and patient, with the doctor unwilling to refuse the patient's request for a prescription, to avoid confrontation.
What do you think are the most important messages to get across to the public?
Take your doctor's advice on whether an antibiotic is needed in your case or not. Don't take antibiotics that have not been prescribed for you. Head colds, the flu and most sore throats are viral and will usually resolve in a couple of days with rest, fluids and simple analgesia (for example paracetamol). Don't stock up on antibiotics that you can buy over the counter in other less regulated countries.
An opinion piece called “The antibiotic course has had its day” was published in the British Medical Journal on 26 July saying that we should stop advising patients to complete the course of antibiotics prescribed. It argues that overuse is the real danger for antibiotic resistance, saying that different patients respond differently, that the 10-14 day treatment period for beta-lactam antibiotics is not based on evidence, that for example a shorter course is just as effective as a longer one for hospital-acquired pneumonia and contributes less to antibiotic resistance and that medical professionals and educators should tell the public we were wrong. The piece has also had a lot of pushback, and global public health organisations still advise completing the course. Where do you stand on the matter? Practically, what should we say when educating people?
This article makes a number of excellent points. We must ensure that the antibiotics prescribed and the duration of treatment are evidence based. Longer courses are not necessarily better. However, the responsibility here should rest with the prescriber to ensure that the appropriate drug, dose and duration are selected. We should not ask the patent to decide when he / she is better. Stopping an antibiotic too soon can also contribute to antibiotic resistance. Encouraging patients to stop antibiotics early also increases the likelihood of them having left over antibiotics at home, which they may take inappropriately on a later occasion.
Lots of research is underway looking for alternatives to antibiotics, like phage therapy and predatory bacteria. Do you see any potential there? What do you think the future looks like for bacterial infections?
Phage therapy holds definite potential for the future, but more trials and research are needed.
Thank you! For more information on what you can do to slow the spread of antibiotic resistance, click here. For more on new tools science is trying to defeat bacteria, click here.