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Introduction to Back up/Delayed Prescribing

Prof. Paul Little explains the context for the importance of antibiotics and how previous antibiotics may have medicalised the illness
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So what am I going to talk about? A brief intro initially about the context and medicalisation, talk about the trial evidence, systematic reviews of the trials, the cohort evidence, some of the barriers to use, and then some practical advice about what next. OK. A bit of context. I won’t go through this slide in huge detail, but basically to orientate you, down the left hand side we have the common things we see, otitis, sore throat, sinusitis, or bronchitis, prior duration, duration of seeing the doctor, total duration untreated, benefit from antibiotics, and the number needed to treat.
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And just– the precise days are not important, but my rule of thumb is quite useful, half a week, a week, two weeks, and three weeks for these four conditions, and a number needed to treat in all of these cases of an excess of 10. So basically, antibiotics probably don’t do terribly much for symptoms for most of the folk we see. But it’s a Friday afternoon, you’re running late, a young man comes in with his partner and says, I’ve had antibiotics last year for tonsillitis. And I’ve got tonsillitis again, doctor. So do you say no? They’re attending because they believe antibiotics cause it to settle last time, so are you, in effect, medicalising an illness?
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OK, so the question is how important is medicalising an illness? In this case, a acute respiratory illness. Well, the problem is, and here we go, a nice iceberg, most people who have their sore throats or respiratory infections don’t bother coming and seeing us. If you contact NHS Direct, we’ll probably see about one in 10, and secondary care about one in 3,000.

Paul explains the context for the importance of antibiotics and how previous antibiotics may have medicalised the illness leading to patients believing that they NEED antibiotics to make them well.

Do antibiotics help much?

In this video Paul shows a graph demonstrating the most common reasons why patients come into clinician surgery and explains why antibiotics would not be useful to them.

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TARGET Antibiotics – Prescribing in Primary Care

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