BAY Health and Wellbeing

With Dr Chris Johns

Some useful medical advice from Dr Chris Johns who has been a GP in Sketty and Killay Medical Centres for 25 years and is Clinical Lead for Swansea Acute GP Unit in Singleton Hospital.

My word, it’s been a very difficult winter so far for our Health Services. Our hospitals are really struggling to deal with the unprecedented numbers of patients attending for treatments in Accident and Emergency, requiring an ambulance, or requiring medical admission. PLEASE try to use your Health Service appropriately.

As there are a lot of infections around, particularly viral infections, the difficult question often asked by patients and doctors is “when are antibiotics needed?”

So I thought I would title this month’s offering:

MARCH2015DrChrispic

Antibiotics – the good, the bad and the ugly”

Where are we compared with the rest of Europe?

In the UK we prescribe 18.7 doses of antibiotics per day per 1000 people. That sounds like a lot but actually in the UK we are at the lower end of the table. Greece does worst with 39.4. We are better than France and Spain but worse than Germany and much worse than Holland. Estonia is the best for some reason, I have no idea why.  Every year in the European Union it is estimated that over 25,000 people die of antibiotic-resistant bacterial infections, mostly acquired in hospitals. This is despite the major progress achieved and efforts made by the European Union, particularly in surveillance and awareness.

What is the problem?

Antibiotic resistance is an everyday problem in all hospitals across the UK and Europe. The spread of resistant bacteria in hospitals is a major issue for patients’ safety.

Infections with antibiotic-resistant bacteria increase levels of disease and death, as well as the length of time people stay in hospitals.

Inappropriate use of antibiotics may increasingly cause patients to become colonised or infected with resistant bacteria.

Few new antibiotics are being developed. As resistance in bacteria grows, it will become more difficult to treat infection, and this affects patient care.

In today’s healthcare and community settings, we are already seeing germs stronger than the drugs we have to treat them. This is an extremely scary situation for patients and healthcare workers alike. Antibiotic resistant bacteria are bacteria that cannot be fully inhibited or

killed by an antibiotic. The antibiotic may have worked

effectively before the resistance occurred. Bacteria become resistant to antibiotics by adapting their structure or function in some way that prevents them from being killed by the antibiotic. This mechanism might happen in several ways:

bacteria can neutralise the antibiotic before it has an effect

bacteria may be able to pump the antibiotic out

bacteria may be able to change the site (receptor) where the antibiotic normally works

bacteria can mutate and transfer genetic material that codes for resistance to other bacteria

The resistant bacteria that survive the effect of the antibiotic are able to multiply, spread to others and cause further infections in the family, community, and/or health care setting. In turn, these infections are more resistant to another round of the same antibiotic.

What is causing this problem?

Inappropriate use and prescribing of antibiotics is causing the development of resistance.

Inappropriate use includes:

not taking your antibiotics as prescribed

skipping doses of antibiotics

not taking antibiotics at regular intervals

saving some for later

Inappropriate prescribing includes:

unnecessary prescription of antibiotics

unsuitable use of broad-spectrum antibiotics

wrong selection of antibiotics and inappropriate

duration or dose of antibiotics

VIRAL INFECTIONS

Many common infections of the nose, throat, sinuses, ears, and chest are caused by germs called viruses. Flu-like illnesses are also caused by viruses. Diarrhoea and/or being sick (vomiting) are often due to a viral infection of the gut. If you are normally well, your defence (immune) system is good at fighting off many types of viral infection.

An antibiotic medicine is not needed if a virus is causing an infection. This is because:

Antibiotics do not kill viruses. Antibiotics only kill bacterial infections.

Antibiotics may cause side-effects such as diarrhoea, rashes, feeling sick, etc.

Overuse of antibiotics when they have not been necessary has led to some bacteria becoming resistant to them. This means that some antibiotics might not be as effective when they are really needed.

How long do viral infections last?

Middle ear infection         4 days

Sore Throat                    7 days

Common Cold              10 days

Sinusitis                         18 days

Cough and Bronchitis      21 days 

You may feel unwell for several days or more until a viral infection clears. Treatment aims to ease symptoms. Treatments that are commonly advised for viral infections include the following:

Paracetamol or ibuprofen to reduce a high temperature (fever), and to ease aches, pains, and headaches.

Making sure you drink enough to prevent mild loss of water from the body (dehydration). Dehydration may develop if you have a high temperature, and it

can make a headache and tiredness much worse.

Do not wrap up, but try to cool down if you have a high temperature. This is particularly important in children. If a child has a high temperature then take their clothes off (in a warm, but not hot, room) and consider giving some paracetamol or ibuprofen.

Other advice may be given for specific symptoms. For example, decongestants for a blocked nose, etc. Ask a pharmacist for advice.

So have patience, I know we all want to get better as soon as we possibly can but good sense should always prevail.

What can patients do to help?

Do not ask for antibiotics when your doctor thinks you do not need them. Give straight forward infections a chance to get better without antibiotics. Remember it takes time for viral infections to get better.  Remember antibiotics have side effects.

Take antibiotics exactly as the doctor prescribes. Do not skip doses. Complete the prescribed course of treatment, even when you start feeling better.

Only take antibiotics prescribed for you; do not share or use leftover antibiotics. Antibiotics treat specific types of infections. Taking the wrong medicine may delay correct treatment and allow bacteria to multiply.

Do not save antibiotics for the next illness. Discard any leftover medication once the prescribed course of treatment is completed.

Prevent infections by practicing good hand hygiene and getting recommended vaccines.

The amount of antibiotics handed out by hospital doctors rose by 12% and by GPs by 4% between 2010 and 2013, producing a 6% rise overall, despite growing fears that overeager prescribing risks the drugs no longer being able to be relied upon. So it is not altogether the fault of patients demanding treatment. Health Care professionals need also to be sensible and prudent as well. We all have a responsibility to ensure antibiotics continue to be effective and are only used when absolutely necessary. We need to work together!

See you next month in TheBAY!!!                   

Chris

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