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At the individual level, I've always thought of antibiotic misuse as (at least in some part) a symptom of our resistance to authority. People end their antibiot

At the individual level, I've always thought of antibiotic misuse as (at least in some part) a symptom of our resistance to authority. People end their antibiotic course early (and then usually use the remaining pills another time) because, of course, they know better. I've run into people like this many times. Now, perhaps doctors should take part of the blame for not explaining why you should finish your course of antibiotics, but users should take some of the responsibility too.

rwallace 10y ago
To play devil's advocate, since this doesn't seem to get mentioned often: 1. People ending their antibiotic course early is a drop in the ocean compared to the abuse of antibiotics in agriculture. 2. The advice to finish the course was coined back when GPs did house calls. Now, if you use up all your current supply, what do you do next time you get sick? By the time you know you need an antibiotic, you're not going to be well enough to hump your arse across town to petition a doctor for a prescription. The official answer might be to call an ambulance, but the ambulances and hospitals are hopelessly overloaded already, and that's nevermind the situation in the US where a hospital visit can bankrupt you even if you have insurance.
- lunchladydoris 10y ago
  People shouldn't have a supply for use when they feel like it. Antibiotics are a last resort, not first! If someone has some left over then they did not finish the previous course, which means that they have potentially allowed the strongest bacteria from the previous illness to live on. Maybe it's not common knowledge, but taking antibiotics is essentially putting evolution into overdrive. At first you kill off the weakest bacteria and then only later the most able to survive. If someone ends their course early, they are allowing the best adapted bacteria to live on and multiply. Perhaps the person wouldn't be getting sick the second time if they had finished their course in the first place. Also, taking antibiotics also does harm to a person's own flora, not just the invaders. So, please don't take antibiotics if you don't need them, and finish them when you do need to. Edit: removed extra 'not' in first paragraph.
- DanBC 10y ago
  Don't play devil's advocate. Only advocate positions you believe in. 2) is countered by the fact that antibiotics are not needed by most of those people; and antibiotics don't reduce the severity or duration of the disease by much. See for example conjunctivitis. Most people attend their doctors and expect to be given antibiotics. This is the case even though doctors find it hard to tell the difference between bacterial and viral conjunctivitis; and that antibiotics don't reduce the severity of the illness, and only reduce duration by one third of one day. http://bjgp.org/content/early/2016/07/05/bjgp16X686125 http://bjgp.org/content/early/2016/07/05/bjgp16X686125
  - rwallace 10y ago
    Well, in this case it's not that I'm saying 'yes, holding onto a personal supply of antibiotics is the right answer', it's that I'm saying there is a real problem to which the official advice offers no solution. Conjunctivitis is certainly a good example. As for what would be a solution, I think it would be helpful if you could get basic medical advice and an antibiotic prescription over the phone. (To the person about to point out the potential downsides of this - yes, I'm aware of them – but what's your better solution?)
    - DanBC 10y ago
      http://www.nhs.uk/Conditions/Conjunctivitis-infective/Pages/Introduction.aspx http://www.nhs.uk/Conditions/Conjunctivitis-infective/Pages/... In the UK this advice is available from pharmacists, over the phone using NHS 111, or online from NHS Choices.
  - ZenoArrow 10y ago
    >"Don't play devil's advocate. Only advocate positions you believe in." That's terrible advice. The main reason for playing Devil's advocate is to try to see things from a different perspective to build a fuller understanding. This is frequently useful.
    - DanBC 10y ago
      > This is frequently useful. Not on HN it isn't.
- manarth 10y ago
  Now, if you use up all your current supply, what do you do next time you get sick? By the time you know you need an antibiotic How do you know you need an antibiotic? Even doctors are discouraged from self-prescribing, so without seeing a medical practitioner, and having whichever tests they feel are appropriate for the symptoms, how can you be sure that those antibiotics are the correct treatment? If, say, you were experiencing diarrhea which was preventing you from going to the GP, then an over-the-counter remedy such as Immodium should give enough short-term relief to allow a visit to the GP. If you really are so severely unwell that you can't reach a GP, then perhaps an ambulance really is appropriate. To address your question of hospital-induced bankruptcy, that's a dysfunction in the US healthcare system: it doesn't make it medically appropriate to keep a stash of antibiotics, although it does contribute to unsafe practices such as self-diagnosing and self-treatment.
  - rwallace 10y ago
    > How do you know you need an antibiotic? An excellent question. If house calls aren't going to be brought back, the best I can think of is to allow consulting over the phone. > If you really are so severely unwell that you can't reach a GP, then perhaps an ambulance really is appropriate. Come on, if everyone called an ambulance every time they were too sick to travel, the system would probably collapse under the overload. Besides, every time you set foot inside a hospital, you expose yourself to the risk of picking up an antibiotic-resistant infection.
    - manarth 10y ago
      If house calls aren't going to be brought back, the best I can think of is to allow consulting over the phone. My local (UK) GP does do this, although I'm not sure how widespread this is. The times I've had a GP consult over the phone, I've been happy with the outcome. My GP surgery does also offer home-visits, although they ask for a telephone consult first. if everyone called an ambulance every time they were too sick to travel I was thinking specifically of cases where someone is too sick to travel, but also doesn't improve for a couple of days. Many illnesses such as winter vomiting bug (norovirus) and food poisoning are usually short-lived, and will either ease off enough to allow the patient to get to the GP, or be severe enough that a GP wouldn't treat it in any case, but instead refer it to a hospital.
vixen99 10y ago
They should indeed. Would it be too much to expect literate people to read the bit of paper that comes in the prescription package making clear that the patient should complete the course.
askvictor 10y ago
There is actually very little evidence as to what should constitute a full dose of antibiotics[1], and some doctors and researchers are now starting to discuss this (however, due to public health message concerns, it's mostly kept pretty quiet). In many infections, once bacteria fall below a certain level, the body's immune system can kill off the remainder. [1] https://www.mja.com.au/journal/2015/202/3/knowing-when-stop-antibiotic-therapy https://www.mja.com.au/journal/2015/202/3/knowing-when-stop-...

rwallace 10y ago

To play devil's advocate, since this doesn't seem to get mentioned often: 1. People ending their antibiotic course early is a drop in the ocean compared to the abuse of antibiotics in agriculture. 2. The advice to finish the course was coined back when GPs did house calls. Now, if you use up all your current supply, what do you do next time you get sick? By the time you know you need an antibiotic, you're not going to be well enough to hump your arse across town to petition a doctor for a prescription. The official answer might be to call an ambulance, but the ambulances and hospitals are hopelessly overloaded already, and that's nevermind the situation in the US where a hospital visit can bankrupt you even if you have insurance.

lunchladydoris 10y ago
People shouldn't have a supply for use when they feel like it. Antibiotics are a last resort, not first! If someone has some left over then they did not finish the previous course, which means that they have potentially allowed the strongest bacteria from the previous illness to live on. Maybe it's not common knowledge, but taking antibiotics is essentially putting evolution into overdrive. At first you kill off the weakest bacteria and then only later the most able to survive. If someone ends their course early, they are allowing the best adapted bacteria to live on and multiply. Perhaps the person wouldn't be getting sick the second time if they had finished their course in the first place. Also, taking antibiotics also does harm to a person's own flora, not just the invaders. So, please don't take antibiotics if you don't need them, and finish them when you do need to. Edit: removed extra 'not' in first paragraph.
DanBC 10y ago
Don't play devil's advocate. Only advocate positions you believe in. 2) is countered by the fact that antibiotics are not needed by most of those people; and antibiotics don't reduce the severity or duration of the disease by much. See for example conjunctivitis. Most people attend their doctors and expect to be given antibiotics. This is the case even though doctors find it hard to tell the difference between bacterial and viral conjunctivitis; and that antibiotics don't reduce the severity of the illness, and only reduce duration by one third of one day. http://bjgp.org/content/early/2016/07/05/bjgp16X686125 http://bjgp.org/content/early/2016/07/05/bjgp16X686125
- rwallace 10y ago
  Well, in this case it's not that I'm saying 'yes, holding onto a personal supply of antibiotics is the right answer', it's that I'm saying there is a real problem to which the official advice offers no solution. Conjunctivitis is certainly a good example. As for what would be a solution, I think it would be helpful if you could get basic medical advice and an antibiotic prescription over the phone. (To the person about to point out the potential downsides of this - yes, I'm aware of them – but what's your better solution?)
  - DanBC 10y ago
    http://www.nhs.uk/Conditions/Conjunctivitis-infective/Pages/Introduction.aspx http://www.nhs.uk/Conditions/Conjunctivitis-infective/Pages/... In the UK this advice is available from pharmacists, over the phone using NHS 111, or online from NHS Choices.
- ZenoArrow 10y ago
  >"Don't play devil's advocate. Only advocate positions you believe in." That's terrible advice. The main reason for playing Devil's advocate is to try to see things from a different perspective to build a fuller understanding. This is frequently useful.
  - DanBC 10y ago
    > This is frequently useful. Not on HN it isn't.
manarth 10y ago
Now, if you use up all your current supply, what do you do next time you get sick? By the time you know you need an antibiotic How do you know you need an antibiotic? Even doctors are discouraged from self-prescribing, so without seeing a medical practitioner, and having whichever tests they feel are appropriate for the symptoms, how can you be sure that those antibiotics are the correct treatment? If, say, you were experiencing diarrhea which was preventing you from going to the GP, then an over-the-counter remedy such as Immodium should give enough short-term relief to allow a visit to the GP. If you really are so severely unwell that you can't reach a GP, then perhaps an ambulance really is appropriate. To address your question of hospital-induced bankruptcy, that's a dysfunction in the US healthcare system: it doesn't make it medically appropriate to keep a stash of antibiotics, although it does contribute to unsafe practices such as self-diagnosing and self-treatment.
- rwallace 10y ago
  > How do you know you need an antibiotic? An excellent question. If house calls aren't going to be brought back, the best I can think of is to allow consulting over the phone. > If you really are so severely unwell that you can't reach a GP, then perhaps an ambulance really is appropriate. Come on, if everyone called an ambulance every time they were too sick to travel, the system would probably collapse under the overload. Besides, every time you set foot inside a hospital, you expose yourself to the risk of picking up an antibiotic-resistant infection.
  - manarth 10y ago
    If house calls aren't going to be brought back, the best I can think of is to allow consulting over the phone. My local (UK) GP does do this, although I'm not sure how widespread this is. The times I've had a GP consult over the phone, I've been happy with the outcome. My GP surgery does also offer home-visits, although they ask for a telephone consult first. if everyone called an ambulance every time they were too sick to travel I was thinking specifically of cases where someone is too sick to travel, but also doesn't improve for a couple of days. Many illnesses such as winter vomiting bug (norovirus) and food poisoning are usually short-lived, and will either ease off enough to allow the patient to get to the GP, or be severe enough that a GP wouldn't treat it in any case, but instead refer it to a hospital.

vixen99 10y ago

They should indeed. Would it be too much to expect literate people to read the bit of paper that comes in the prescription package making clear that the patient should complete the course.

askvictor 10y ago

There is actually very little evidence as to what should constitute a full dose of antibiotics[1], and some doctors and researchers are now starting to discuss this (however, due to public health message concerns, it's mostly kept pretty quiet). In many infections, once bacteria fall below a certain level, the body's immune system can kill off the remainder. [1] https://www.mja.com.au/journal/2015/202/3/knowing-when-stop-antibiotic-therapy https://www.mja.com.au/journal/2015/202/3/knowing-when-stop-...