A common tricky scenario: A patient comes in with symptoms of a cold, or a similar viral type illness.

The conversation usually is along the lines of ‘this never goes away without antibiotics’, or ‘I wouldn’t normally ask but I am on holiday next week’.

There then is a bit of an awkward discussion about why antibiotics are not a good idea in this case.

The problem is this. The Chief Medical Officer of England, among many others, has suggested that resistance to antibiotics by bacteria is one of the biggest health threats the country faces.

Put simply, the little blighters are clever and the more we use antibiotics, the more they learn to survive.

If we are not careful, when it comes the serious infections (pneumonia, sepsis, meningitis etc), we won’t have any drugs that work, which is a bad place to be.

GPs are often accused of over-prescribing antibiotics.

In reality there are many thousands of prescriptions that are written for patients who have viral infections.

These patients will get no benefit at all from antibiotics.

Worse still, antibiotics have side effects. Not many in honesty, but there are enough that you would want to be sure that you could benefit from them before taking them.

So why are antibiotics prescribed when they are not needed? I think the answer is pressure. There is the pressure not to miss a serious infection. There is pressure to be able to ‘cure’ all illnesses, and there is pressure generally from a society that doesn’t allow people to be unwell, even if for a week. There is also the pressure for time-pressed doctors who sometimes think that it is quicker to give antibiotics than to take the time explaining why they are not needed.

None of this is an excuse, but it is important to understand the reason things happen. It is hard to make sure that, as a doctor, you pick the one out of a 100 who would become quite unwell without antibiotics. A good example I saw this week is scarlet fever. This looks initially like a viral infection with a temperature and a sore throat in a child.

However, the temperature is higher, there is often a spotty rash and a characteristic strawberry tongue. This needs antibiotics, without which there is a risk of heart problems. In fact there are lots of older people, in the days before antibiotics, who will remember having rheumatic fever.

If we give antibiotics to everyone with these symptoms, they won’t work. But when they are needed, they are very effective and literally life-saving. So when it comes down to it, we will generally take the safer option.

The message is out there and most people are pretty reasonable about this. In fact, research has shown that a lot of doctors assume people wanted antibiotics when in actual fact they didn’t. What we need is an honest convers-ation about this, and a need for under-standing about the risks and benefits. Not only for the sake of individuals, but also for society as a whole.