The NHS wastes tens of millions of pounds each year on antibiotics, but the money is trivial compared to the problem of resistance.
Shortly after I joined my practice, my senior partner gave me a memoir to read. It was written by a doctor called Kenneth Lane who had worked in the practice from the late 1920s. As I read stories from his 40-year career, I was struck by Lane’s detailed knowledge of the natural course of infectious diseases, something unfamiliar to my generation. In the case of a child with pneumonia, for instance, Lane would prepare the parents for each deterioration they could expect over the first eight to ten days, culminating in the “pneumonic crisis” – a crescendo of fever, hypoxia and delirium that would, in a quarter of cases, be fatal. Only once the crisis had been survived would Lane start to talk about the possibility of recovery.
Lane never lost the awe he experienced when, in the 1940s, the first antibiotics became available. Suddenly, feared diseases such as diphtheria, pneumonia and scarlet fever could be cured within days. To a doctor used to watching impotently as otherwise fit young people died, these new drugs were miraculous.
I wonder what he would make of how we use them today. Roughly 35 million prescriptions for antibiotics are issued each year in England, mostly for respiratory infections (coughs, colds, sore throats, sinusitis, earache). Studies have repeatedly shown that, in these scenarios, antibiotics do little or no good. The infections are going to get better anyway and antibiotics don’t reduce severe complications, which are, in any event, rare. They do shorten symptom duration by about half a day on average but up to 10 per cent of patients experience side effects. And there is good evidence that antibiotic use interrupts the development of a robust immune response, which makes people susceptible to contracting further infections. The more you use antibiotics, the more you will end up using them.
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Re-blogged from www.newstatesman.com