Why won’t my doctor give me antibiotics? Ron Daniels explains.

Summary

Ron Daniels is a Consultant in Critical Care, Vice President of the Global Sepsis Alliance, Chief Medical Officer of the United Kingdom Sepsis Trust, and a Topic leader for Patient Safety Learning’s hub. 

In this interview, Ron explains why doctors have to carefully manage the use of antibiotics in order to protect patients, now and in the future. 

Content

What’s the issue with prescribing antibiotics?

For decades we have been using antibiotics to treat and reduce infection, and to stop people dying from infection. Unfortunately, some of the bacteria (and related organisms) we’ve been fighting have become resistant to certain types of antibiotics (or antimicrobials, in the case of other germs such as viruses, parasites and fungi). This is also known as antimicrobial resistance (AMR). Lots of people wrongly think that a patient can become resistant to antibiotics. It’s the bug, not the person. 

Prescribing antibiotics unnecessarily leads to more and more bugs becoming resistant, leaving patients with fewer treatment options. This is already having a huge impact on healthcare as we know it, with thousands of people affected. We need to manage the risks now, and as we move forward into the future. 

What does this mean for patients?

If you become poorly with a bug that is resistant to a type of antibiotic, prescribing that antibiotic to you will not make you better. Your symptoms will remain or get worse. As you can imagine, this makes those particular bugs very difficult to treat, and serious life-threatening infections like sepsis more likely to occur. Worryingly, statistics indicate that patients in more deprived areas are more likely to be affected. 

If a doctor is concerned that you are unwell with a bug that cannot be treated with the usual ‘first choice’ course of antibiotics, they may change it or prescribe something called a ‘broad spectrum antibiotic’ to help you feel better. In some circumstances, this is lifesaving. 

Unfortunately using these ‘broad spectrum antibiotics’ can lead to even more bugs becoming resistant to even more types of antibiotics. There also tends to be more side effects for the patient. 

What are the big risks?

There are a number of risks and challenges that have to be really carefully managed around the use of antibiotics. 

Essentially, we want to make sure:

1. Standard and broad-spectrum antibiotics are not being prescribed unnecessarily and contributing to the issue of an increasing number of bugs being resistant to our treatments. 
2. Patients get the antibiotics they need and do not become seriously unwell or at risk of sepsis. 
3. Health inequalities do not widen. 

How do doctors know what to do for the best?

Deciding whether or not to give antibiotics to a patient, and which type is best if you do, can be very difficult. There are tests that can identify what type of bug a patient has and what it is resistant to. There are other tests – called biomarkers – which can help with the decision as to whether or not antibiotics are needed at all. These tests can really help healthcare professionals make decisions around antibiotics, but these services are not yet widely available.

What do you hope to see in future?

We need to help the public understand these issues and how they are affecting healthcare and decision-making. Many people visiting their doctor will strongly believe that antibiotics are the solution to their problem. There can be a lot of pressure to prescribe them, and it can be hard to explain why that’s not always the best approach. 

If someone looks very sick, their GP will be sending them straight to hospital. But if not, having access to a biomarker test in the community would help people feel reassured and support that important doctor-patient relationship, especially when antibiotics are not being prescribed.  

Doctors need to be empowered to make the best and safest decisions for their patients. I believe we should be piloting having biomarker testing within close access to GP surgeries. For those patients deemed in need of antibiotics, further tests should guide the choice of medicine. That way, patients could quickly and easily be offered testing, and the rapid results would help their doctor decide whether to prescribe antibiotics and if so, which type would be most effective. Focusing the pilots in urban areas where there is significant variation in wealth would also help us understand and manage the risk of widening health inequalities.  

These actions could help reduce unnecessary antibiotic use and protect patients from serious infection. Ultimately, helping to limit the threat to human life both now and in the future.

Related content

• Top picks: 14 key resources on antimicrobial resistance
• Tackling antibiotic underdosing: Interview with Ruth Dando, Head of Nursing for Theatres, Critical Care and Anaesthetics at BHRUHT
• What factors in the workplace enable success in antimicrobial stewardship in paediatric intensive care?
• Tackling antimicrobial resistance: How to keep antibiotics working for the next century
• Antimicrobial resistance survivors: calling the world to action
• Patient capacity building for advocacy and research: The case of the European Patient Group on Antimicrobial Resistance
• Department of Health and Social Care: Confronting antimicrobial resistance 2024 to 2029

About the Author

Dr Ron Daniels BEM is a consultant in Critical Care at University Hospitals Birmingham NHS Foundation Trust. He is a Fellow of the Royal College of Physicians of Edinburgh, Royal College of Anaesthetists and Faculty of Intensive Care Medicine.

Ron is Vice President of the Global Sepsis Alliance, having been instrumental in bringing World Sepsis Day and the World Sepsis Declaration to fruition. In May 2017, following unanimous approval of the Executive Board of the World Health Organization, he was part of an Executive Board that secured the adoption of a Resolution on sepsis by the 70th World Health Assembly.

He is also Founder and Chief Medical Officer of the United Kingdom Sepsis Trust, a registered charity, in which capacity he provides clinical advice to NHS England, the UK Health Security Agency and the Department of Health and Social Care. He has lobbied the UK Government and devolved governments in Scotland and Wales over several years, resulting in the development of a national commissioning incentive for sepsis in England, a NICE Clinical Guideline and Quality Standard and public awareness campaigns on sepsis.