Healthy Skepticism Library item: 12481

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Publication type: news

Smith R.
Stop giving antibiotics for colds, doctors told
The Daily Telegraph 2008 Jan 11
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/01/09/nbiotic109.xml

Abstract:

Doctors are to be told to stop prescribing antibiotics for coughs, colds and sore throats because over-use of the drugs is fuelling the spread of killer hospital superbugs.

Full text:

Alan Johnson, the Health Secretary, says it is time to end the unnecessary use of penicillin and other commonly-prescribed pills, which cost the NHS £1.7 billion a year.

Using antibiotics too liberally has led to bugs such as MRSA becoming resistant to treatment with the drugs. Most colds, coughs and flu are caused by viruses, which cannot be treated with antibiotics anyway, Mr Johnson points out.

Announcing a £270 million campaign against superbugs, to be launched next month, he says it is vital that doctors adopt “less of a knee-jerk reaction to prescribing”.

The campaign, called Clean, Safe Care, will also include an extra £45 million for hospitals to spend on infection control nurses or antibiotic specialist pharmacists. All patients going into hospital will be screened for MRSA by 2009.

Staff have already been told they must be “bare below the elbows” to help prevent the spread of infection between patients and all hospitals should undergo a “deep clean” by March this year, although experts have dismissed this as a gimmick.

Mr Johnson says: “The past 60 years have seen great advances in health care and medicine. For example, the use of antibiotics has saved countless lives, but antibiotics do not work on most coughs, colds and sore throats and their unnecessary use can leave the body susceptible to gut infections like Clostridium difficile.”

Over-use of antibiotics, which can be used only on bacterial infections, has been blamed for the rise of drug-resistant tuberculosis. The drugs can strip natural bacteria from the gut and allow C.diff to take hold and kill vulnerable elderly people.

Too-liberal use of antibiotics, especially when patients do not finish their courses, allows multiplication of bugs that have mutated to become resistant.

If antibiotic use is not curbed, doctors could run out of effective treatment as certain bugs become resistant to more and more drugs. Pharmaceutical companies are unwilling to invest the billions of pounds needed to research and develop new antibiotics because they are not very profitable.

Dr Mark Enright, professor of molecular epidemiology at Imperial College London, said even common bacterial infections do not really need treating with antibiotics and usually go away on their own.

“In the old days, before we had problems with resistance, people thought it really didn’t matter – you could throw antibiotics at these cases and you would pick up the odd one that was treatable that way,” he said.

“I am sure there are still GPs who think they know best and think antibiotics are the global panacea we once thought they were.”

The most common antibiotic ingredient, amoxicillin – one of the penicillin family – has become less effective because more bugs have become resistant to it. Other common generic antibiotic ingredients that are less effective include cefaclor, used for chest infections, and trimethoprim, used to treat urinary tract infections.

Prof Kevin Kerr, consultant microbiologist at Harrogate District Hospital, said the pressure on GPs to prescribe antibiotics can be immense. In some cases patients are told by one doctor in the practice that they do not need antibiotics only for them to book with another partner who is more willing to capitulate.

He said: “These campaigns are desperately needed. The focus has been on cleanliness and washing hands but without closing the circle by tackling prescribing it is only half the battle.”

Norman Lamb, the Liberal Democrat health spokesman, said: “The Government has ignored the link between antibiotics and hospital infections for too long. Over-prescribing of broad-spectrum antibiotics is very dangerous.”