Antibiotics and hospital infections

Behind the Headlines

Wednesday January 9 2008

Picture of a man sneezing

Colds are viral infections and cannot be treated with antibiotics

The overuse of antibiotics is fuelling the spread of hospital infections, such as Clostridium difficile (C. diff) and MRSA, The Daily Telegraph and the Daily Mail report. Doctors are being asked to stop prescribing antibiotics for common conditions such as coughs, colds and sore throats. The clampdown is part of a £270m investment to tackle hospital infection control and cleanliness in the NHS. Announcing the Clean, Safe Care strategy, health secretary Alan Johnson said the unnecessary use of antibiotics “can leave the body susceptible to gut infections like Clostridium difficile”.


What are antibiotics?

Antibiotics are chemical substances that kill off bacteria. They don’t work against viruses. The first antibiotic, penicillin, was discovered by Sir Alexander Fleming in 1928. Many other antibiotics have been developed since.


What’s the difference between bacteria and viruses?

Bacteria are a one-celled living organism whereas a virus is little more than a section of DNA covered by a protein shell. Bacteria cells can reproduce by themselves while a virus multiplies by attaching itself to a living cell – killing it in the process. Amongst all the organisms that can infect humans, some bacteria are now known to be less harmful than once thought and some are beneficial.


What is the problem with the over-use of antibiotics?

Over time, bacteria can become resistant to certain antibiotics. In a large population of bacteria, those that are not killed by the antibiotic, can survive and reproduce. This creates a treatment-resistant strain of bacteria. MRSA (meticillin-resistant Staphylococcus aureus) is one example of a strain of bacteria which is resistant to most antibiotics.


Do doctors over-prescribe antibiotics?

Recent research suggests that antibiotics are often unnecessary and that some GPs do prescribe antibiotics when they are not absolutely essential, often at the request of patients. However, doctors have been warned in the past about the over-use of antibiotics, and in general GPs are well aware of the risk involved.


Why do antibiotics not work on coughs, colds and sore throats?

Most coughs and sore throats and all colds are viral infections. Most people recover from common viral infections as soon as the illness has run its course, usually about five to 10 days.


Why is this relevant to hospital superbugs?

Most antibiotics are prescribed by GPs; making sure that GPs and patients only use antibiotics to treat bacterial infections, not viral infections, is key in preventing the emergence of resistant strains of bacteria. The more often antibiotics are used, the more likely bacteria are to become resistant to them, so keeping their use to a minimum will help. Once resistant bacteria, such as MRSA, emerge they can take hold in vulnerable hospital patients more easily and can prove fatal.


Is Clostridium difficile a superbug?

No. At present it is a bacterial infection that can be treated relatively easily, although there is evidence that some strains have started to acquire resistance to several antibiotics in common use.

C. diff is a bacterium that is normally found in the gut, where it rarely causes problems. However, it can cause illness when its growth goes unchecked. Patients with diarrhoea, especially if severe or accompanied by incontinence, may unintentionally spread the infection to other patients, and this may lead to outbreaks of C. diff in hospitals. The very young and old people are particularly susceptible to C. diff.


Can we develop new antibiotics to replace ineffective ones?

To develop and make a new drug is an expensive and long-drawn-out process as well as being of high financial risk. A pharmaceutical company typically has to put a drug through five to 10 years of trials before it is given a safety certificate to go on the market. A drug can fail at any stage of this process and, more importantly, drug resistance can develop more quickly than this. This means bacteria can be resistant to a drug before it is available on the market.


What can I do?

Do not expect to be prescribed antibiotics as a matter of course when you visit your GP. If you are prescribed antibiotics for a bacterial infection, make sure you take the drugs regularly and, even if you soon begin to feel better, make sure you finish the complete course of drugs.

Analysis by NHS Choices

Edited by NHS Choices

Links to the headlines

Stop giving antibiotics for colds, doctors told. The Daily Telegraph, January 9 2008

Doctors told to stop giving out antibiotics for common illnesses due to superbug fears. Daily Mail, January 9 2008

Hospital bug strategy is set out. BBC News, January 9 2008

Pushy patients blamed for rise of superbugs. The Guardian, January 9 2008 

Further reading

Del Mar CB, Glasziou PP, Spinks AB. Antibiotics for sore throat. Cochrane Database Syst Rev 2006, Issue 4

Nelson R. Antibiotic treatment for Clostridium difficile-associated diarrhea in adults. Cochrane Database Syst Rev 2007, Issue 3

Davey P, Brown E, Fenelon L, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2005, Issue 4

Dendukuri N, Costa V, McGregor M, Brophy JM. Probiotic therapy for the prevention and treatment of Clostridium difficile-associated diarrhea: a systematic review. CMAJ 2005; 173:167-170 [DARE Abstract]


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