Friday, November 18, 2011

An open letter to Dr Fidelma Fitzpatrick HSE Clinical Lead for the Prevention of Healthcare-associated Infection

Dear Dr Fidelma Fitzpatrick,

I have just read the 'the journal' article ‘HSE wages war on unnecessary antibiotics use’ in which you are quoted talking about the need to wage a war on the growing resistance to antibiotics.  As the daughter of a retired Medical Scientist and Lab Technician, I am very familiar with this war.  From a young age, I was trained to always finish my courses of antibiotics and I was disgusted when I changed GPs to one nearer college and found that he seemed to prescribe antibiotics for everything I went to him about, whether it seemed to be bacterial or not.

But I believe that, in targeting the public with the message ‘do not take antibiotics for viral illnesses’ you are sending the wrong message to the wrong people.  The message to the public should simply be ‘finish any course of antibiotics you start and only take antibiotics that are prescribed for you and at the time they are prescribed for you’.  The message needs to go out loud and clear to DOCTORS not to prescribe antibiotics when they are not necessary.  It seems that doctors prescribe antibiotics for viral illnesses to provide a placebo effect and satisfy patients who feel that they should leave a doctor’s surgery with medicine of some sort.  This is not ok.  Patients go to doctors because the doctors are supposed to know best when it comes to the patients’ health.  Doctors need to stand their ground on what treatment they know to be best.

If people are taking too many antibiotics, it is because doctors are prescribing too many antibiotics.

The article also quotes ‘the HSE’ as saying that ‘taking antibiotics for a viral illness is:
-          A waste of a life-saving resource, and can cause bacteria to become resistant to antibiotics, so they may not work if you take them properly in the future
-          A waste of GP fees and prescription fees, or for medical holders a waste of taxpayers’ money
-          A waste of time – visiting the GP and taking time off work
-          A waste of time for the GP who doesn’t need to see patients with colds and flu.’

I agree only with one and a half points.  Yes, it is a waste of a life-saving resource.  Yes, it is a waste of prescription fees and in taxpayer’s money in the case of medical card holders.  But it is not a waste of GP fees, GPs time, patients time or time off work.  People who have viral infections, including colds and flu, are sick.  When you are sick it is perfectly reasonable to go to your doctor.  It is up to the doctor to diagnose the illness and prescribe the correct treatment, even if it is just bed rest.

Patients should not be expected to diagnose the source of their own illness before going to a doctor.  They should be able to trust doctors not to prescribe the incorrect treatment.

The HSE has diagnosed the illness; people are taking too many antibiotics.  But it has prescribed the wrong treatment.


Updated to add her reply:

Dear Sorcha

Thank you for your email and apologies for only getting back to you today.  I was out of the country giving a lecture from Friday afternoon so only back today.

The public education campaign is part of a bigger package which includes a GP education programme via the ICGP and also printing out updated antibiotic prescribing guidelines, an updated patient information leaflet and a ‘no antibiotic prescription’ sheet for GPs (see   The campaign has been developed by a group of healthcare professionals which included GPs and also modified after feedback from patients and members of the public.  The reason that we have included a public education campaign is that we know that there is misinformation among some patients and members of the public that antibiotics work on colds and flus and we want to address this also.

Studies have shown that prescriber (mainly GP) education alone does not produce a sustained reduction in inappropriate antibiotic use: patient and public education is needed as well.   Data from other countries show that for many conditions (particularly upper respiratory infections), antibiotics are prescribed when they are not needed in up to 50% patients.   We know that public expectation and pressure can influence prescribing decisions, and that public education has been shown to be an essential component in reducing inappropriate antibiotic use.  A Europe-wide survey, which included Ireland, showed that members of the public often mistakenly believe that antibiotics can hasten recovery from upper respiratory tract infections (coughs & colds) and prevent more serious illness.  Such misconceptions were lower in countries that have succeeded in maintaining low levels of inappropriate antibiotic use.  Surveys have shown that nearly half of the adults that go to their doctor expect an antibiotic once they get there.  In the US between a third and half of patients of parents with children presenting with mild respiratory symptoms said that they expected an antibiotic for a cough and cold.

Antibiotic use peaks every winter in Ireland, during cold and flu season, hence why the campaign will run over the Winter months.  We know from published evidence from other countries (e.g., France, Belgium, UK, Australia) that these type of campaigns do help improve public understanding of when antibiotics work and also help reduce antibiotic prescribing. 

You are absolutely right with your point regarding the importance of completing antibiotic courses, hence why we have included this in our patient information leaflet and also a downloadable powerpoint for GPs that they may wish to run in their waiting rooms.  Of course it is important that if somebody is concerned/feels unwell that they still go to their doctor – the thrust of the patient information leaflet is that if you do go to your doctor and your doctor does not feel an antibiotic is warranted, then don’t pressurize your doctor for one, rather ask what you can do to feel better.I don’t think the campaign is the wrong treatment – there is misinformation among our patients and members of the public regarding the role of antibiotic is colds and flu so the campaign is trying to address this and from other countries there is evidence that it does this.  Of course though it needs to be part of a bigger package which is why it has included an update of the GP prescribing guidelines.

Thank you for taking the time to email me – I appreciate your feedback.  If you have any other comments or thoughts as to how a campaign like this could be developed over a number of years please let me know.


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