Antibiotics are the wonder drug of the last century, but is their time coming to an end?

Though immunisation fairly claims the crown for saving the most lives, antibiotics have allowed us to live without the fear of life-threatening infections. Gangrene, Leprosy and Tuberculosis - all were killers and now are treatable, but are the good times coming to an end?

Increasingly, the infections we used to treat with antibiotics, like those with Mycobacterium tuberculosis, pictured left,  are becoming resistant to them.  Lives are being lost and a startling new World Health Organisation report (http://www.who.int/mediacentre/news/releases/2014/amr-report/en/) details the stark future we face if we are not more careful with this precious resource.

It is not overstating the risk to suggest that antibiotics may effectively 'run out' long before oil reserves are exhausted.

The key causes of antibiotic resistance that apply to us as doctor and patient are:

1. Over-prescribing of antibiotics

2. Not finishing the antibiotic course

3. Sharing antibiotics

These are all linked - Doctors prescribe antibiotics, the patient improves, some are left over and given to a relative...

We try to help by:

• Telling you if we don't think your infection needs antibiotics.
• Making sure that we use the simplest antibiotic for the job (this often means fewer side effects)
• Using rapid strep tests to see if you really need antibiotics for your sore throat.
• Trying not to use oral antibiotics (tablets or syrup) when a simpler treatment or a cream will do the same job.
• Prescribing the right length of antibiotic course to ensure all the bacteria are killed.

The last point is worthy of further comment. Not finishing the antibiotic course has long been thought of as a leading cause of antibiotic resistance as antibiotics never kill all the bugs in your body - your immune system actually does most of the work. If you stop the course early, some resistant bugs may survive and either cause you to develop a resistant infection or spread to others.  Longer courses of antibiotics do, however, lead to more antibiotics being used and getting into the environment so we try hard to give you the right length of trreatment course.  These courses are generally getting shorter as we come to realise that almost everyone gets better very quickly once the worst of the infection is cleared up.

Many infections, even those that involve bacteria will almost always get better without antibiotics and this is where doctors and patients often end up having difficult conversations. 

Good examples include acute sinusitis, acute bronchitis and most sore throats.  Even though there may be pus or green mucus present, often an antibiotic is not beneficial.  These conditions usually get better on their own.  That having been said, antibiotics do sometimes make a difference so it is still worth a trip to the doctor.

So, next time your doctor does not prescribe antibiotics, don't feel cheated and don't think you have wasted our time (or yours) we are making a professional judgement that helps to protect you, your family and your community and preserving antibiotics for when they are really needed.

Credits:

The following images are used with the kind permission of their creators under the Creative Commons Licence.

Mycobacterium tuberculosis: NIAID

Sore throat: badlyricpolice