Page 22 - July - Sept 2023 Edition

ANTIBIOTICS

Article by Dr Dick Stockley
Antibiotic resistance was a hot topic a few
years ago, and nothing has changed
except the media interest. There is still
increasing antibiotic resistance, and still no Dr Dick Stockley
really new categories of antibiotics being
produced, just the tweaking of old ones. long discussion on an international medical
Public ignorance I suggest has certainly education site asking why doctors in USA
increased: rising demand and expectation prescribed azythromycin for upper
of a need for an antibiotic has never respiratory tract infections: basically, for viral
stopped. Strictly speaking an antibiotic is common colds. They said that patients
made or derived from living organisms, demanded their “z-pac”. It was advertised
mostly fungi. However, there are entirely direct to the consumer for “respiratory
manufactured drugs, technically infections” with claims that most respiratory
“chemotherapeutic agents” such as organisms were resistant to other
nitrofurantoin, that are classed as antibiotics: actually true of course,
antibiotics. To keep it simple I will refer to because no antibiotic is of any use in a
any drug that kills bacteria as “an viral infection. If the doctors didn’t prescribe
antibiotic”. it, they went to another doctor who would,
And that is the most important thing to and then complained to the insurance.
understand. They kill bacteria. They do not Those complaints meant the doctors lost
cure disease or heal injuries or speed customers. The result is that the best,
recovery. They do not stop coughs or realistically the only effective, treatment for
reduce pain or cause surgical wounds to dysentery, cholera, typhoid and some std’s
heal. Killing bacteria might result in a cure, is now facing increasing antibiotic
or expedited recovery, or help an injury resistance because it’s prescribed for
recover: but the antibiotic only kills bacteria coughs and sore throats.
or in some cases, cause horrible side If I ruled the world I would restrict the use of
effects. This might be rather obvious to azythromycin to only those diseases.
some of you, but believe me there are
some strange beliefs out there. When I first So, when are antibiotics needed? Across
started work in a hospital in Uganda, an Europe there are big differences in the rate
injection of streptomycin and penicillin was of prescriptions, the Dutch prescribe the
given to every patient after surgery “to least and some of the southern countries
make the wound heal”. When I didn’t the most. If the Dutch prescribe 4 x fewer
prescribe the magic needle, the patients antibiotics than the Italians do, does that
begged the nurse for the injection that mean that thousands of Dutch die from
healed the scar, fully convinced that if they untreated infections? Or does it mean the
didn’t get it, then when the sutures were Spanish are swallowing a lot of
removed the wound would burst. I have unnecessary antibiotics? In Kampala a few
heard tourists asking for antibiotics for years ago before I retired, a colleague
coughs, I have seen pharmacists give doing research in this area told me that in
Amoxyl syrup as cough syrup. I have seen Uganda country wide on average 80% of
people with twisted ankles given antibiotics: patients got a prescription for antibiotics.
it’s hot painful and swollen it must be an So, I looked at our practice in The Surgery.
infection, right? Our rate was 20% if we included
Aminosidine for amoeba. If we excluded
This is not a third world problem. Not long Aminosidine it was about 8%. Personally, I
ago an official health spokesman for the had a tooth infection a few years back
E.U. said that 80% of prescriptions for and I took a course of penicillin V. It was my
antibiotics in the E.U. for respiratory only antibiotic apart from Aminosidine for
infections were not necessary. There was a giardia for about 20 years.

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