1. Dr Simon Pettitt GP Goring and Woodcote Medical Practice
Antibiotics
Dr Simon Pettitt GP
Goring and Woodcote Medical Practice 1

2. Why are we worried…
ANTIBIOTIC USE 2

3. Antimicrobial resistance poses ‘catastrophic threat’, says Chief Medical Officer
British Society for Antimicrobial Chemotherapy 3

4. PROBLEM 1.
No new antibiotics of significance have been developed since the late 1980’s 4

5. History of antibiotics
1953
Glycopeptides
Nitroimidzoles
Streptogramins
1962
Quinolones
Fusidic Acid
1946
Nitrofurans
1978
Oxazolidinones
1957
Rifampacin
1950
Pleuromutilins
1987
Lipopeptides
1932
Sulphonamides
1945
Tetracyclines
1971
Mupirocin
NOTHING!!
1920
NOW
1928
Penicillins
1943
Aminoglycosides
1948
Cephalosporins
1952
Macrolides
1955
Cycloserine
Novobiocin
1961
Trimethoprim
1969
Fosfomycin
1976
Carbapenems
1979
Monobactams 5

6. PROBLEM 2.
Bacteria are becoming resistant to existing antibiotics at an alarming rate 6

7. 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 7

8. Median age to multiply
25-29 years (2010 est)
Versus minutes 8

9. Goring and Woodcote Medical Practice
How do we do? 9

10. 10

11. 11

12. How are we doing? We are doing well We want to better
We need your help doing this
Managing expectation
Educating 12

13. How do we do? Oxfordshire Goring and Woodcote
23% below national average for total antibiotic prescribing
Goring and Woodcote
4th highest prescriber total antibiotics in South East Oxfordshire 13

14. Antibiotic Prescribing 2016/1714

15. 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 15

16. What Does This Tell Us…? The top three antibiotics prescribed
Trimethoprim
Used for urinary tract infections
Flucloxacillin
Used for skin infections
Cellulitis
Abscesses 16

17. Do You Need Them? Glue ear/middle ear infection Sinusitis
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 17

18. Do You Need Them? Sore Throat and Tonsillitis Urinary Tract Infections
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. 18

19. A Design Masterpiece
The body has amazing capacity to fight infection and repair itself
Antibodies
White blood cells 19

20. Cephalosporins/Quinolones/Co-amoxiclav
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 20

21. Good vs. Bad Bacteria 21

22. Why the fuss
Clostridium difficle 22

23. Have your flu/pneumococcal/shingles vaccines where appropriate
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 23

24. 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 24

25. 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. 25

26. 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. 26

27. Antibiotics have side effects
Nausea
Vomiting
Diarrhoea
They can make the side effects of statins worse 27

28. The GP’s Dilemma Safe and appropriate Antibiotic prescribing
Sepsis and severe infections 28

29. 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 29

30. 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 30