Antibiotics Dr Simon Pettitt GP Goring and Woodcote

Antibiotics Dr Simon Pettitt GP Goring and Woodcote Medical Practice

Why are we worried… ANTIBIOTIC USE

• Antimicrobial resistance poses ‘catastrophic threat’, says Chief Medical Officer British Society for Antimicrobial Chemotherapy

PROBLEM 1. • No new antibiotics of significance have been developed since the late 1980’s

History of antibiotics 1953 1946 Nitrofurans Quinolones Fusidic Acid 1978 Oxazolidinones 1957 1950 1932 1962 Glycopeptides Nitroimidzoles Streptogramins 1945 Pleuromutilins Rifampacin Sulphonamides Tetracyclines 1987 1971 Lipopeptides Mupirocin NOTHING!! 1920 1928 Penicillins 1943 Aminoglycosides 1948 1952 1961 1969 1979 Macrolides Trimethoprim Fosfomycin Monobactams Cephalosporins 1955 Cycloserine Novobiocin 1976 Carbapenems NOW

PROBLEM 2. • Bacteria are becoming resistant to existing antibiotics at an alarming rate

Antibiotic resistance • More and more antibiotics are becoming less effective against bacterial infections • We run the risk of not being able to treat infections in the future • Bacterial multiply very quickly • It has taken humans hundreds of thousands of generations to evolve from beneficial mutations • Bacteria can do this in months/years

Median age to multiply 25 -29 years (2010 est) Versus 20 -30 minutes

Goring and Woodcote Medical Practice • How do we do?

Items per STAR PU

How are we doing? • We are doing well • We want to better • We need your help doing this – Managing expectation – Educating

How do we do? • Oxfordshire – 23% below national average for total antibiotic prescribing • Goring and Woodcote – 4 th highest prescriber total antibiotics in South East Oxfordshire

Tr ox i ici m Ph e en th llin ox Flu op ym cl rim et oxa hy ci l Ni lpen lin tro ic fu ill. . . r Do ant o Cl xyc in ar yc ith lin Co rom e -a yc m i Er ox n yt ic hr lav Ci om pr yc of in lo x Ce acin fa le xin Am Antibiotic Prescribing 2016/17 Items/1000 patient 9 8 7 6 5 4 3 2 1 0 Items/1000 patient

What Does This Tell Us…? • The top three antibiotics prescribed – Amoxicillin • Used for lower respiratory tract infections – – Chest infections Pneumonia Bronchitis Laryngitis • Used for upper respiratory tract infections – Sinusitis – Middle ear infections/Glue Ear

What Does This Tell Us…? • The top three antibiotics prescribed – Trimethoprim • Used for urinary tract infections – Flucloxacillin • Used for skin infections – Cellulitis – Abscesses

Do You Need Them? • Glue ear/middle ear infection – Common but often resolve spontaneously – 80% will get better without antibiotics in 3 days • Sinusitis – Common and unpleasant; but… – No place for antibiotics where the presentation is uncomplicated – Risk of harm from antibiotics is 1 in 8

Do You Need Them? • Sore Throat and Tonsillitis – Day 3 – 40% better without antibiotics – Day 7 – 85% will be symptom free without antibiotics • Urinary Tract Infections – Uncomplicated UTI is the commonest bacterial infection in women, but symptoms may resolve without antibiotic treatment.

A Design Masterpiece • The body has amazing capacity to fight infection and repair itself – Antibodies – White blood cells

Cephalosporins/Quinolones/Coamoxiclav • Cephalosporins – e. g. Cephalexin • Used for chest infections and urinary tract infections • Quinolones – e. g. Ciprofloxacin • Used for urinary tract infections • Co-amoxiclav – e. g. Augmentin • Used for ENT/Chest/bowel/skin infections

Good vs. Bad Bacteria

Why the fuss • Clostridium difficle

• We want antibiotics to WORK in the RIGHT patients when they are NEEDED. • Hand washing • Have your flu/pneumococcal/shingles vaccines where appropriate • Ensure that children have their childhood immunisations • Rest, keep fluids up, symptom management

Things I hear as a GP • “I need antibiotics because I am going on holiday” • Unfortunately antibiotics are unlikely in many cases to help an infection resolve quicker

Things I hear as a GP • “I’ve got a terrible virus doctor. I need some antibiotics” • Most infections are caused by VIRUSES, not bacteria. • Antibiotics don’t work for viruses. • You’re body is the only thing that will handle most viral infections.

Things I hear as a GP • “I need antibiotics Doc… Dr X gave me some last time and they really sorted me out. . ” • Infections are rarely the same twice. Just because antibiotics have worked previously, it doesn’t automatically mean they are needed this time.

Antibiotics have side effects • • Nausea Vomiting Diarrhoea They can make the side effects of statins worse

The GP’s Dilemma Safe and appropriate Antibiotic prescribing Sepsis and severe infections

In conclusion • G&W Medical Practice is a low prescriber of antibiotics and a low prescriber of c. difficile causing antibiotics. • However…. – We can always be better • Most people who ask for antibiotics don’t need them • The number of patients needs to treat is outweighed by the number of patients needed to harm

Help us to Help you • Help yourself – With many ‘viral’ infections symptoms can be managed. – Many of these treatments are readily available over the counter at your local pharmacists • If you have a sick child and are worried please call us and ask for advice – We are always more than happy to give advice when you are not sure