Royal College of General Practitioners

Antibiotics are ‘not for snot’

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Running noses and green phlegm do not mean patients need antibiotics, say doctors and public health experts.

It was described as a “prevailing myth” that the drugs were needed to treat such infections.

Snotty child

Public Health England and the Royal College of General Practitioners said the symptoms were often caused by viruses.

And the use of antibiotics was leading to resistance, they said.

Public Health England said its own research showed that 40% of people thought antibiotics would help a cough if the phlegm was green, while very few thought it would make a difference to clear-coloured phlegm.

Dr Cliodna McNulty, from the organisation, said: “It’s a prevailing myth that anyone with green phlegm or snot needs a course of antibiotics to get better.

“Most of the infections that generate lots of phlegm and snot are viral illnesses and will get better on their own although you can expect to feel pretty poorly for a few weeks.

“The problems of antibiotic resistance are growing. Everyone can help by not using antibiotics for the treatment of uncomplicated infections.”

Taking antibiotics affects the trillions of bacteria that naturally live in the human body and can lead to resistance.

Dr Maureen Baker, chairwoman of the Royal College of GPs, said: “Overuse of antibiotics is a serious public health concern.

“Infections adapt to antibiotics used to kill them and can ultimately make treatment ineffective so it’s crucial that antibiotics are used appropriately.”

The green colour in phlegm and snot is the result of a protein made by the immune system to fight infection.

The latest advice comes on European Antibiotics Awareness Day.

Each GP saves 4.7 lives a year, say researchers.

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save life

Each GP saves nearly five lives a year, shows the first study to estimate the impact of disease prevention by practices.

Researchers estimated the public health impact (PHI) score for all practices in England and found 139,100 lives were saved nationally as a direct result of disease preventation activities in 2009/2010.

This equated to an average, per GP, of 4.71 lives saved a year.

The research, to published be in the British Journal of General Practice next month, is the first to quantify the impact of GPs on lives saved, with the PHI score calculated based on 20 QOF indicators, including those for flu vaccination, smoking cessation advice, and HbA1c control.

QOF data was taken from 8,136 general practices in England for the study, 97.97% of all practices.

They found the mean estimated PHI score was 258.9 lives saved per 100,000 registered patients, per year. This represented 75.7% of the maximum potential PHI score of 340.9.

The researchers said they hoped the PHI score would help CCGs to assess the impact of practices more accurately and lead to better public health outcomes.

Study leader Dr Mark Ashworth, a GP in south-east London and clinical senior lecturer at King’s College London, said that the study gave GPs a real measure of how much good they are doing in the community.

He said: ‘What this is doing for the first time is giving GPs a feel that, actually, all that disease prevention work they do translates into something really tangible.

“This figure is a way of looking at how well you are doing which is not so much using the management agenda, which is so often what’s being applied to general practice. It is using something that means much more to GPs, and much more to patients. It translates into a figure for lives saved.’

He added that the score was not necessarily related to high overall QOF scores: ‘You’ve got other sets of practices that don’t do very well at QOF – so aren’t said to be doing very well in terms of care performance – and yet their PHI score is very high.

‘It gives you some sense that QOF isn’t fully rewarding the practices that have necessarily performed best in terms of saving lives out in their community.’

Source: http://www.pulsetoday.co.uk

 

 

 

‘Most family doctors’ have given a patient a placebo drug.

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Most family doctors have given a placebo to at least one of their patients, survey findings suggest.

In a poll, 97% of 783 GPs admitted that they had recommended a sugar pill or a treatment with no established efficacy for the ailment their patient came in with.

The PLOS One study authors say this may not be a bad thing – doctors are doing it to help, not to deceive patients.

The Royal College of GPs says there is a place for placebos in medicine.

But they warn that some sham treatments may be inappropriate and could cause side effects or issues such as drug resistance.

For example, one of the placebo treatments identified in the study was antibiotics for suspected viral infections.

 “Start Quote

This is not about doctors deceiving patients”

Dr Jeremy HowickThe study’s co-author

Antibiotics are powerless against viruses and doctors are told not to use them.

About one in 10 of the GPs in the study said they had given a patient a sugar pill or an injection of salty water rather than a real medicine at some time in their career.

One in 100 of them said they did this at least once a week.

‘Offering reassurance’

Almost all of the GPs said they had provided patients with treatments, like supplements, probiotics and complementary medicines, that were unproven for their medical condition. Three-quarters said they offered unproven treatments on a daily or weekly basis.

Dr Jeremy Howick, co-author of the study that was carried out by the University of Oxford and the University of Southampton, said: “This is not about doctors deceiving patients.

The power of placebo

The placebo effect – when the patient feels better despite taking a medicine with no active ingredient – can be surprisingly strong.

One study even found patients with irritable bowel syndrome reported improvements despite knowing they were taking a dummy pill.

And its not just pills, fake acupuncture has been shown to reduce the severity of headaches and migraines.

The effect is based on the patient’s expectation of a cure and seems to work best for subjective measures such as pain.

The size, colour, and branding of placebo treatments have all been shown to influence ‘effectiveness’.

The placebo is the backbone of medical research enabling doctors to distinguish between real and expected or perceived effects of treatment.

But when it comes to their use in general medicine some believe their use can damage the doctor-patient relationship.

The question is whether the patient minds as long as they have their ‘cure’.

“The study shows that placebo use is widespread in the UK, and doctors clearly believe that placebos can help patients.”

The GPs in the study said they used placebos either because patients requested treatment or to reassure patients.

Half said they told their patients that the therapy had helped other patients without specifically telling them that they were prescribing a placebo.

Dr Clare Gerada, chairwoman of the Royal College of GPs, said it was perfectly acceptable to use a placebo as long as it did not cause harm and was not expensive.

“Lots of doctors use them and they can help people.

“If you think about it, a kiss on the cheek when you fall over is a placebo.

“But there are risks. Not all of the placebo treatments that the researchers looked at in this study are inert. If you take too many vitamins, for example, some can cause harm.”

She said fobbing off patients with an ineffectual treatment was never acceptable. “But admitting to your patient that you do not know exactly what is going on, but that a therapy might help is.”

Source:BBC