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My throat is killing me! Another round of antibiotics?

By Dr Vinith Menezes, General Practitioner at The Neighbourhod Clinic

“Hi Doc, this will be a quick one – I’ve got tonsillitis again. Just need a script for some antibiotics to knock it on the head!” – Brad, 28yo IT consultant

Turns out Brad has had three sore throats this winter and he’s fed up with being sick – fair enough! His previous GP used to give him antibiotics each time and he got better. At this point Brad feels confident about what he needs. The easiest thing would be to print out a quick script.

But wait … is that the best option?

Is having three sore throats in a single winter ‘normal’?

Thousands of years ago when humans lived mostly in nomadic tribes, we probably came into close contact with far less people than we do today. Viruses have always been around, but the button on the tram door and the self check-out touch screen at Woollies have each come into contact with more humans in a single day than many of us would have touched in a lifetime. We live in a hyper-connected world, and for the viruses of 2018, it’s time to party. This means multiple colds every year could be normal, even with a decent immune system. But alcohol/poor sleep/poor nutrition also play a role.

Have antibiotics actually helped in the past?

Have antibiotics actually helped Brad in the past? Well, maybe, but the odds aren’t great. Most sore throats (including tonsillitis) are caused by viruses for which antibiotics do nothing except the placebo effect - which is a real effect, but it’s the same as taking a fake pill. As you can see from the below info-graphic, most people get better, but few people actually get better BECAUSE of antibiotics, and some get harmed by them!

Why would his previous GP have prescribed antibiotics?

Two generations ago, probably due to crowded housing, scarlet fever and rheumatic fever were relatively common – today they are RARE complications of strep throat (a particular bacterial throat infection). GPs that trained in that era had good reason to be worried!!

Bu the simplest reason is that clearly Brad would be a happy client if given his script and sent on his way – he has come to this appointment with a clear expectation. Additionally, medicare funding of general practice favours brief consultations. So the GP is left with a choice; they can either spend a large amount of time and energy explaining why antibiotics is probably not beneficial and risk an unhappy patient, or just give Brad the script. The third option of course is a privately billing clinic (like the Neighbourhood Clinic) that allows us the time to explain things properly.

Sore Throat: Should I Take Antibiotics, is there a risk?

Is there risk of harm in antibiotics? Like all medicines, antibiotics do have risks. Life threatening allergy is the most severe – though uncommon. Thrush (especially in women), rash and diarrhoea are more common but much less dangerous. Antibiotic resistance is a growing risk worldwide – this is not a risk to Brad, but it is for our communities, and particularly for the next generation. Drug development is frankly not keeping up with rapid bacterial evolution, and it means when we really need antibiotics to save our lives (eg. in intensive care units) … they may not work!

This is getting out of hand. So, what should Brad do????

Brad should seek a professional opinion from his local GP about the best way forward. The GP will look for signs that Brad might actually benefit from antibiotics, or find other early signs of complications. And as with most GP consultations, it’s likely something else will come up – like his anxiety, his weight or his loud snoring …

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