COPD and antibiotics…

I found this stating-the-bleeding-obvious gem in today’s Search Medica newsletter:-

Dramatic benefits for early antibiotics in at-risk patients with LRTI**

Prescribing antibiotics on the day of diagnosis of a lower respiratory tract infection, ‘dramatically’ reduces admissions and mortality related to respiratory infection, UK research reports. Antibiotic prescribing on the day of diagnosis lowered the rate of admissions by 27% and reduced mortality by as much as 69%.

(**LRTI includes COPD flare-ups.)

Well, hey, I’ve been saying that for ages (Ron’s Rants passim) – the sooner antibiotics are started, the sooner the infection is controlled. It’s not sodding rocket science, and you don’t need research to know that – just simple observation and common sense.

I’ve been buying my own antibiotics for nearly 5 years now for that very reason, because it’s impossible to get them from my GP, when I have a COPD flare-up, without submitting to a sputum test, which can take a week and which, of course, I spend getting worse. Then they’ll almost inevitably recommend one of the very few antibiotics that disagree with me.

I take my antibiotics according to the GOLD guidelines for COPD, i.e. at the first signs of purulence. Those of you with COPD will know that, at the start of the day, sputum can be pretty foul anyway, so my test for purulence is that it persists throughout the day. Once that happens I initiate a 7-day course of 500mg Amoxyl every 8 hours; if that’s inadequate, I’ll extend it to 14 days. If the infection is particularly bad, I’ll start with a loading dose of 2 x 500mg capsules.

In five years that routine has failed me only 3 times, needing me to see my GP. Compare that to the more normal once every 4-5 weeks, and it’s pretty damned obvious it’s beneficial, but the NICE-induced paranoia about prescribing antibiotics puts the needs of the patient last.

In the light of the predicted flu pandemic, and the risks to COPD patients from secondary infections, that has to change.