{"id":33387,"date":"2015-02-19T12:55:31","date_gmt":"2015-02-19T11:55:31","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=33387"},"modified":"2015-02-19T13:22:35","modified_gmt":"2015-02-19T12:22:35","slug":"jim-sherifi-i-am-an-antibiotic-resistance-denier","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2015\/02\/19\/jim-sherifi-i-am-an-antibiotic-resistance-denier\/","title":{"rendered":"Jim Sherifi: I am an antibiotic resistance denier"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/02\/Jim-Very-Good2.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-33388\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/02\/Jim-Very-Good2-150x150.jpg\" alt=\"Jim Very Good[2]\" width=\"150\" height=\"150\" \/><\/a>I write as a humble jobbing GP incapable of sound clinical practice without instruction, guidance, and\u00a0supervision from the\u00a0National Institute for Health and Care Excellence (NICE), my clinical commissioning group, my colleagues, or by reading today\u2019s newspapers. Despite practising\u00a0medicine for 40 years, it is apparent to all that I am still incapable of differentiating a minor viral\u00a0infection from a potentially more serious bacterial one.<\/p>\n<p>I am profligate with my antibiotic prescribing, and am personally responsible for &#8220;<a title=\"Sally Davies\" href=\"http:\/\/www.bbc.co.uk\/news\/health-21737844\" target=\"_blank\">antibiotics resistance being as grave a threat as terrorism<\/a>&#8221;\u00a0(Sally\u00a0Davies, chief medical officer for England). I&#8217;m the go-to guy to blame for this threat to the &#8220;<a title=\"Daily Mail\" href=\"http:\/\/www.dailymail.co.uk\/news\/article-2957851\/GPs-bonus-doing-job-Doctors-rewarded-cutting-antibiotics-bosses-fear-losing-power-fight-infections.html\" target=\"_blank\">survival of the human race<\/a>&#8221; (Mark Baker, director for clinical practice at NICE).<!--more--><\/p>\n<p>And yet I do sometimes feel that I am being made\u00a0the scapegoat for a phenomenon that may not be entirely understood, but for which a simple, practical hypothesis seems compelling. A scenario not unlike that for global warming, where we have\u00a0endeavoured to reduce our carbon emissions in the UK for decades only to find that last year was\u00a0globally the hottest on record.<\/p>\n<p>So this week&#8217;s &#8220;naughty boy&#8221; <a title=\"NICE\" href=\"https:\/\/www.nice.org.uk\/news\/press-and-media\/safeguarding-our-defences-against-disease-nice-sets-out-approaches-to-stop-infections-developing-resistance-to-antimicrobial-medicines\" target=\"_blank\">diktat from NICE<\/a> sent me straight to the detention room where I\u00a0had to write a thousand lines of &#8220;I must not be an antibiotics resistance denier.&#8221; However, instead I\u00a0came across an <a title=\"The BMJ\" href=\"http:\/\/dx.doi.org\/10.1136\/bmj.g5493\" target=\"_blank\">article<\/a> published in <em>The BMJ<\/em> only five months ago. It looked at antibiotic prescribing in\u00a0primary care from a slightly different perspective; one of antibiotic failure when used in first line\u00a0treatment in four common areas: upper respiratory infections, lower respiratory infections, skin and\u00a0soft tissue infections, and acute otitis media. The overall failure rate for treatments rose in absolute\u00a0terms from 13.9% in 1991 to 15.4% in 2012 or, to put that another way, over a 20 year period up to 2012, antibiotic\u00a0failures rose by 1.5%.<\/p>\n<p>The most commonly used antibiotics in the study were the venerable\u00a0amoxicillin, penicillin V, and flucloxacillin. Now I\u2019m no clinical research physician, and I am certainly no\u00a0statistician, but I reckon that the parameters of this excellent study could be used as surrogate\u00a0markers for antibiotic resistance for <em>S. pneumoniae<\/em>, <em>S. aureus<\/em>, <em>H.influenzae<\/em>, and other common\u00a0bacterial pathogens\u2014and yet such resistance in a clinical setting seems to have progressed at a glacial\u00a0pace. An increase of 1.5% over 20 years hardly extrapolates to Armageddon by 2050.<\/p>\n<p>I then looked at overall prescription numbers for antibiotics. Undeniably, there has been a jump in\u00a0the past three years, yet the number of antibiotic prescriptions issued in 2014 (41.6 million) is exactly the same as\u00a0that for 1998. A blip is not synonymous with a trend.<\/p>\n<p>Finally, I cannot help looking at my own experience in general practice over 30 plus years. GPs see many\u00a0cases a week of potential viral or bacterial infections. Using our clinical judgement we prescribe\u00a0antibiotics for some of these cases. Regardless of aetiology, most get better. In truth I cannot\u00a0remember the last time I admitted a patient to hospital with an unresolving infection. The\u00a0antibiotics I use now are 95% unchanged from those I used in the 1980s.<\/p>\n<p>And so, despite all the &#8220;overwhelming evidence&#8221; to the contrary, I find that I remain an antibiotics\u00a0resistance denier. The only regret that I have in being so is in seeing the confidence and self-esteem\u00a0of a once proud profession being yet again maligned by\u2014and I am being charitable here\u2014well meaning but alarmist sound bites emanating from a national body such as NICE.<\/p>\n<p><em><strong>Jim Sherifi<\/strong> has worked as a GP in East Anglia since 1980, and has held a number of roles within GP education and compliance. He spent four years as an executive search consultant, aka &#8220;headhunter,&#8221; in the commercial sector.<\/em><\/p>\n<p>Competing interests: None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>I write as a humble jobbing GP incapable of sound clinical practice without instruction, guidance, and\u00a0supervision from the\u00a0National Institute for Health and Care Excellence (NICE), my clinical commissioning group, my [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2015\/02\/19\/jim-sherifi-i-am-an-antibiotic-resistance-denier\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-33387","post","type-post","status-publish","format-standard","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - 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