Cutting antibiotics by half – NICE strike again…

NICE want to cut the prescribing of antibiotics by half. That is, instead of getting a week’s worth, you’ll get just a few days when your lungs are full of stinking crap (or maybe you’ll get seven days, and half the strength? Who the hell knows with these buggers?). Does that fill you with confidence? It fills me with despair.

After a lifetime of asthma and bronchiectasis I now have severe COPD (I’ve never smoked). My history is one of repeated respiratory infection – once every 4-6 weeks on average throughout my adult life. The idea of antibiotic therapy being halved is absurd and dangerous.

From about 2004, it became impossible to get antibiotic treatment for an infection without a sputum test, despite the fact that I was producing purulent sputum, as anyone with a sense of smell could tell. This should take 24 hours, but it was usually 3-4 days and, if a weekend intervened, a week. Which I’d spend getting worse,

Then I would get a grudging 7 days worth of an antibiotic. I know from long experience that this is often inadequate yet, when I returned to my GP on one occasion, I was told no  more were forthcoming without another sputum test. And more delay while the infection re-established itself.

Once I’d recovered, I decided it was time to take matters into my own hands, and buy my own antibiotics. I certainly had the experience of using them, so I didn’t see a problem.

Five years on, which I’ve spent importing and taking Amoxyl according to the GOLD guidelines, my respiratory health is better than it has ever been. That is because, while I still take 7 days worth, if it needs more, I take more. In that time I have had 3 infections that haven’t responded to Amoxyl, otherwise I’ve been fine and, as of today, I have not had a respiratory infection for four months. That’s a record.

As far as I’m concerned, halving what by any measure is already a  parsimonious level of antibiotic prescribing is a recipe for disaster. Inadequate antibiotics will leave a reservoir of bacteria which, having been exposed to antibiotics but not killed, are very likely to produce antibiotic-resistant strains.

This is just more penny-pinching from the bean-counters at NICE, and the expense of patient care, and the risk of creating yet more resistant bugs. Don’t we have enough?

Oh, and before a doctor comes along and condemns me for an irresponsible patient who doesn’t know what he’s doing, my knowledge of bronchiectasis, asthma, and subsequently COPD, and their treatment, is extensive. It’s something to which I have devoted a great deal of my life, and I know more about the subject that some doctors I’ve met.

I am not, and never have been, a passive and ill-informed patient. I see it as the duty of any chronically-sick person to know as much about their illness as their GP, and preferably more. That way they can discuss proposed treatments with their doctor from a position of knowledge, not ignorance. This should yield better results for both parties.

And seriously, if you have COPD, think very seriously about getting your own antibiotics. If you need advice, post a comment.

By the way, in my entire life – and I’ve depended upon antibiotics since they were released for public use in the fifties – I have only had one chest infection that was cleared up in just 3 days, and that was earlier this year. I think that’s only because my health is so much improved by my self-medicating.

Incidentally, in the eighties, before this antibiotic paranoia struck, I had in stock a dozen 3g sachets of Amoxyl (ha! try getting them now!), at any one time, plus a generous stock of Amoxyl 500mg capsules. Both were on my repeat list, too. Why? Because I had a doctor who trusted me, that’s why (after we’d once had an argument about the heavy use of steroid inhalers and the need for steroid cards; I was right – you do need one – and got a public apology in the waiting room next time I went to see him). Now they treat patients like idiots because they worry the doctor-knows-best days are slipping away. Sorry, doctors, that’s one genie you can’t put back in the bottle.