The GP's view: It's crucial we prescribe the right antibiotics

These days diagnosis is often based on guesswork and dreaded NHS algorithms
Dr Martin Scurr

THE deaths of 12 people in Essex from a rare, invasive bacterial infection, caused by the group A streptococcus bacterium, in June should concern us all.

Most group A strep infections cause mild illnesses, such as strep throat and skin infections – but these recent cases, which mainly occurred among elderly patients in care homes, sadly proved fatal.

We must ask why. I suspect one factor is the modern failure to test before prescribing antibiotics.

There was a time when doctors would take a swab from a patient with a severe sore throat; people with urinary symptoms had to provide a clean catch of urine; and those with a productive cough would be asked for a specimen of sputum. These would then be sent off to a laboratory for analysis.

This meant a decision to treat with antibiotics could be based not only on symptoms, but the bacteria cultured, and the patient would be given antibiotics lethal to that particular infection. Sure, it would mean a wait to get the result – but it was only 48 hours.

This system required a follow-up phone call to the patient to advise them of the result of the analysis and, where necessary, to arrange for a correct prescription.

But now, instead, because of that ‘nuisance’ value and, no doubt, the cost, diagnosis is based on guesswork and dreaded NHS algorithms.

If an antibiotic is prescribed, it’s often the same tired old regimen of amoxicillin or trimethoprim banged out on reflex, rather than utilising the correct drug for the scientifically identified bacteria.

Is this why sepsis is on the rise in England? Cases have more than doubled in three years. Shouldn’t we be doing the best for our patients, taking a bit more time and trouble – and hang the cost?

© Solo dmg media

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