No antibiotics for cough, colds and ear infections in Britain

Patients are to be refused antibiotics for coughs, colds and ear infections, under strict new guidance to doctors. This is right in theory but will undoubtedly lead to deaths among patients with meningococcal infections.

The drugs are not necessary in most cases, do not work against many of the infections and contribute to the spread of lethal hospital superbugs like MRSA, experts said. Family doctors routinely prescribe antibiotics for common respiratory infections such as sore throats. But GPs claim they often feel under pressure from patients who are angered if they are refused treatment.

Now the NHS drugs rationing body, the National Institute for Health and Clinical Excellence (NICE), has issued new guidance to doctors telling them not to prescribe antibiotics to patients who are suffering from minor illneses such as an ear infection, sore throat, tonsillitis, a cold, sinus infection, cough or bronchitis. Instead, doctors will advise them to stay at home and rest while taking painkillers. The move comes after Health Secretary Alan Johnson launched a $540 million advertising campaign earlier this year telling patients that the drugs will not help with a cough or cold.

Sir Liam Donaldson, the Chief Medical Officer, said inappropriate use of antibiotics was fuelling superbug infections as it encourages infections to become resistant to the drugs. Treatment with antibiotics also leaves people vulnerable to gut infections like Clostridium difficile, which can also be fatal particularly in the elderly. Last year 38 million prescriptions for antibiotics were written by GPs at a cost to the NHS of $350 million. Prescriptions to treat respiratory illnesses currently accounting for almost two thirds of all antibiotic prescribing in GP surgeries

The new guidance - which may dismay those who have grown to expect treatment for routine illnesses - says patients should be reassured that antibiotics are not needed immediately because they will "make little difference to symptoms and may have side-effects". They should be told to return to the doctor if they get worse or it does not clear up on its own. Alternatively doctors could issue a prescription for the patient to cash in at a later date if their symptoms get worse or go on for more than a week. Experts say this 'delayed prescribing' works well and doctors say few of the prescriptions are cashed in showing that patients do follow the instructions.

The guidance was welcomed by Professor Steve Field, chairman of the Royal College of GPs, who have been campaigning on the issue. He said: "It costs an absolute fortune. I have always said there is no shortage of money in the NHS - we just need to spend the money on things that are useful. "It can be very difficult being a GP having a consultation with a patient who expects antibiotics. It has become ingrained in them but because the infection gets better anyway, people think it was the antibiotics."

The guidance says doctors should consider giving antibiotics to children under the age of two who have an ear infection in both ears, children who have discharge from the ears and patients who have tonsillitis along with other problems. Antibiotics or further testing should be offered immediately to patients who have symptoms that suggest a serious illness or complications such as pneumonia, or if they are at high risk of complications. This would apply to those who already have a serious condition such as cystic fibrosis, severe heart, lung, kidney or liver disease or whose immune system is compromised.

Patients who are aged over 65 and have a cough should immediately be prescribed antibiotics or sent for further testing if they also fulfill two of the following criteria - having been admitted to hospital in the last year, having diabetes, suffering heart failure or using certain medications. Patients over the age of 80 with a cough need only fulfil one of the other criteria.

Dr Gillian Leng, who was in charge of developing the guidelines and is Deputy Chief Executive of NICE, said: "This is the first practical guideline which will help all healthcare professionals to assess adults and children with respiratory tract infections to decide whether their condition will improve by taking antibiotics. The guidance will also ensure that they can be followed up by the right people, at the right time and within the right healthcare setting."

Mike Sharland, a consultant paediatrician who helped develop the guidelines, said: "Every year, over five million antibiotics are prescribed for children in the community - the great majority for upper respiratory tract infections which are nearly always viral. This guideline describes the evidence base for prescribing antibiotics in children with an upper respiratory tract infection and gives clear and concise recommendations for their use."

Anne Joshua, Associate Director of Pharmacy at NHS Direct, who also helped draw up the guidelines, added: "This short clinical guideline brings together everything we know on targeting antibiotics to those who really need them. It sets out very clearly the information that should be provided by healthcare professionals when they are assessing children and adults presenting with respiratory tract infection symptoms in order to reassure them that they are receiving the most effective course of treatment, based on the most up-to-date evidence."

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Australia: Public hospital emergency power fails

This is pretty disgraceful. Emergency systems should be tested regularly. This one obviously was not

Doctors and nurses had to ventilate patients by hand during a Sydney hospital blackout but its manager says no patients were at risk. Concord Hospital, in Sydney's inner-west, lost power for over an hour on Saturday and emergency generators for the intensive care unit and emergency department failed to kick in. However, the hospital's general manager Danny O'Connor said no patient treatment was compromised.

"Concord Hospital has a comprehensive emergency power supply system. Unfortunately in this instance a component of the system failed," Mr O'Connor said in a statement. "This led to power being interrupted to several wards for about one hour. "Patient treatment was not compromised while the interruption was resolved." Mr O'Connor said the faulty component had been replaced following the incident and the system had been retested and was functioning correctly.

Opposition Leader Barry O'Farrell said Health Minister Reba Meagher needed to explain how such a "catastrophic failure" could occur in one of NSW's largest hospitals. "How is it possible for a contingency electricity supply to fail in the most crucial parts of the hospital - the intensive care unit and the emergency department," Mr O'Farrell said in a statement. "It's a tribute to the outstanding staff that no one died during this major failure."

The NSW opposition wants the government to review all emergency back-up electricity generator systems in public hospitals statewide. NSW Health declined to make any comment saying the statement from Mr O'Connor should explain what happened.

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