Public Educating patients or blaming them? Public education campaigns on antibiotic resistance

Blog in the BMJ, LSHTM tweeted about it today. The "evidence" for patient blaming does not stand up to scrutiny.....

https://blogs.bmj.com/bmj/2019/02/0...education-campaigns-on-antibiotic-resistance/

 

Here patients are being blamed for what is essentially doctor related issues that result in over prescription of antibiotics, in turn thought to be a factor in developing antibiotic resistant bacteria. There are two factors, a willingness to blame patients and doctors' action causing harm.

Are there parallels to the situation in relation to ME and to the emerging group of pseudo psychiatric catch all diagnoses, including MUS syndrome? Certainly a significant percentage of people with ME and one assumes MUS etc feel they are blamed for their health condition and for making 'unreasonable demands' on their doctors. How can we measure the causal factors in doctors' diagnosing, prescribing and refferal behaviours?

Perhaps it would be interesting to examine any relationships between doctors' beliefs about the nature of ME and their choice of treatment/management options. Though this is complicated by the potentially high levels of patients that have given up on their doctors, and by limited availability of specialists to refer on to. Also are the treatments provided, such as GET and CBT, dictated by doctor choices or national policies.

In relation to MUS it might be worth looking at the use of this diagnostic category and the number of patients seen by a doctor. If a doctor is under time pressure will this encourage them to abandon the diagnostic process sooner in favour of a non diagnosis such as MUS?

 

We must blame patients for antibiotic use so that the meat industry can continue on with their mass production on a scale never seen before and the veil isn't lifted on how alleged antibiotic resistance in people has made its way into the human population.

 

An anecdote : I've been told by someone that many patients don't understand how antibiotic resistance occurs. At the time that people were being urged to "complete the course" when they were prescribed antibiotics quite a few patients stopped taking them early because they were worried that by taking too many they personally would become resistant to the antibiotics. They couldn't (mentally) separate themselves from the bugs they were trying to destroy and didn't really understand the logic behind "completing the course".

My understanding : I thought I did understand the logic behind "failing to complete the course" and antibiotic resistance but now I don't. If I have a bacterial infection which can be killed off by antibiotics and I get them prescribed, I get prescribed enough to kill off the infection completely (with luck). If I don't complete the course then the most resistant bugs will survive the onslaught of the antibiotics and will live to multiply and infect me again.

So now, I'm completely baffled by two things :

1) Patients who pulse dose themselves with antibiotics. This is like going into battle for a couple of days then giving the enemy a breather to regroup, get their breath back, have a meal, get a bit of kip, then start attacking me again the next day.

2) Suddenly doctors are telling patients that the advice to "complete the course" is wrong and unnecessary and they should stop taking antibiotics as soon as they feel better. The logic behind this escapes me completely.

Edit : Grammar

 

There was an interesting program on antibiotics on the BBC with Angela Rippon, available on iPlayer
https://www.bbc.co.uk/iplayer/episode/b0c1nl68/the-truth-about-19-antibiotics

 

Just wait til we get the double whammy of post Brexit chlorinated and antibiotic laced chickens ...

 

I think chicken whatever it is now is so far removed from being chicken it is too late anyway to worry about it getting any worse. Just stick some breadcrumbs on it and hope for the best!

 

If you can afford free range it is completely different.

Havn' t had the cash to have anything more than a discounted organic free range chicken breast when Wholefoods shut!
It was like stepping back in time to my childhood.

 

I'm actually baffled by the change as well. I can perhaps explain the original reasoning.

Antibiotic resistance is not (or typically not) coded in the core DNA for bacteria. It's in an "extra" DNA section, known as a plasmid, which is picked up from another microbe (perhaps originally a yeast).

The bacterium will hold onto it if needed, but drop it if not. They can also give a copy to other organisms. This first part is known.

So while treating with antibiotics, the microbes that die first are thought to be the ones without resistance (and without defenses, like biofilms, spores, and whathaveyou).

Theoretically if just a few had resistance, they might be the ones that didn't die, but weren't numerous enough to cause disease. But then when antibiotic therapy stopped, they could pass the plasmid for resistance to other microbes. This middle part was conjecture (from those working and teaching in the field) as far as I recall.

Since they're not recommending necessarily finishing the entire course, I am guessing that any remaining microbes would not necessarily immediately pass the resistance plasmid to other organisms, but maybe drop it instead. But that's just a personal guess based on the recommendation. I have no knowledge of this.

Either that or they're most worried about killing beneficial bacteria.