The news section of the current BMJ (BMJ 2014;349:g5238) runs the headline “GPs feel pressurised to prescribe unneeded antibiotics”. The article states that:    
• 55% of GPs felt pressurised by patients to prescribe an antibiotic (10% of patients expected antibiotics every time and a further 13% expected antibiotics most of the time)
• 44% admitted to prescribing antibiotics to get a patient out of the surgery
• 28% of GPs were not sure of the medical necessity of their prescription
• 24% of GPs felt there was a lack of easy to use diagnostic tools

It’s no wonder that antibiotic resistance is increasing!

Recently I have had a number of calls from primary care
regarding otitis externa. I have "heard" the reason why, Ha ha!! The product Otosporin has been withdrawn by the
manufacturer for unknown reasons and the GPs are now not sure what to use to treat the Pseudomonas aeruginosa
they keep growing. Otosporin was a topical combination of hydrocortisone, neomycin (an aminoglycoside) and polymyxin B sulfate. 

However, the correct question is not what should be used instead of Otosporin, but rather what is the significance of the Pseudomonas aeruginosa and does it need treating at
all.

The other day I received a call about whether a patient could be sent home on self-administered IV antibiotics. The patient had an E. coli septic arthritis and had been on IV Ceftriaxone for 2 weeks. They were no longer febrile, their joint was no longer painful, and their peripheral blood white
cell count and CRP had improved considerably. The E. coli was sensitive to Ceftriaxone and Ciprofloxacin.

I gave advice to switch the patient from IV Ceftriaxone to oral Ciprofloxacin for a further 4 weeks. From the silence that followed it was clear that this wasn’t the advice that was expected. On discussion it became apparent that the team had wanted IV antibiotics because they felt these were better than orals!?

It seems many people believe that IV antibiotics are better than orals, be they the general public or healthcare professionals. I’m unsure where this myth arises but it is not true.