SEPTEMBER 20, 2021

Antibiotics ‘work by killing bacteria or preventing them from spreading’ and are used to treat bacterial infections which fall into the following categories:

  • Infections which would not improve without treatment or would take too long to
  • Those which would potentially infect others
  • Those which carry a risk of more serious complications

You can find examples of health problems that fall into each of these categories on the NHS website

Antibiotics, however, are not required for all bacterial infections, as often mild cases will resolve without their use. ‘Antibiotics are [also] no longer routinely used to treat’:

  • Chest infections 
  • Ear infections in children
  • Sore throats

Similarly, antibiotics are not used to treat ‘colds and flu, and most coughs and sore throats’, as they do not work for viral infections.

The NHS states that ‘antibiotics are no longer routinely used to treat infections because:

  • many infections are caused by viruses, so antibiotics are not effective
  • antibiotics are often unlikely to speed up the healing process and can cause side effects
  • the more antibiotics are used to treat trivial conditions, the more likely they are to become ineffective for treating more serious conditions’

Antibiotics are becoming ineffective due to ‘antibioticresistance’; this occurs when ‘bacteria change in response to the use of these medicines’ and become resistant to antibiotics. As a result, infections caused by these bacterias are ‘harder to treat than those caused by non-resistant bacteria’ and ‘leads to longer hospital stays, higher medical costs and increased mortality’.

The World Health Organization (WHO) warns that ‘antibiotic resistance is one of the biggest threats to global health, food security, and development today’. It also outlines that ‘a growing number of infections – such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis – are becoming harder to treat as the antibiotics used to treat them become less effective’. Likewise the NHS warns overuse of antibiotics has led to the emergence of “superbugs”, which are ‘strains of bacteria that have developed resistance to many different types of antibiotics’. These “superbugs” include:

You can find more information about antibiotic resistance, including ‘prevention and control’ for policy makers, health professionals and the healthcare industry, on the WHO website and the NHS website.

The WHO also provides information on antimicrobial resistance; antimicrobials, which includes antibiotics, as well as antivirals, antifungals and antiparasitics, ‘are medicines used to prevent and treat infections in humans, animals and plants’. ‘Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death’. 

Finally, the NHS website provides additional information about antibiotics, which you may find useful, including people more at risk of bacterial infections and the use of antibiotics to prevent infection, for example if an operation is being carried out.

Ethical considerations & wider issues

The WHO asserts that ‘antibiotic resistance occurs naturally, but misuse of antibiotics in humans and animals is accelerating the process’. This highlights a potentially wider issue relating to patients’ understanding and use of antibiotics. In a survey by BMJ in 2017 ‘most respondents (83% (1404/1691)) recognised that antibiotics kill bacteria/treat bacterial infections, but a sizeable minority (35% (592/1691)) thought that antibiotics kill viruses/treat viral infections’. It also found that ‘overall levels of understanding have not changed substantially since similar surveys in 2003 and 2008/2009’, despite public campaigns. Furthermore, BMJ advised that ‘given that 43% of people [in the survey] who had an infection or took antibiotics in the past year said that they did not receive any advice or information, and that most people trust their GPs advice as to whether antibiotics are needed, there is scope for providing more information about antibiotics and antimicrobial resistance during primary care consultations’. 

As with all research and surveys, there are limitations, and given that this is just one survey, this does not conclusively mean that doctors are not providing their patients with enough information about antibiotics or that public health campaigns are not working. However, given the WHO advice that ‘the world urgently needs to change the way it prescribes and uses antibiotics’, it presents interesting areas to consider and explore further: how does understanding affect antibiotic use and how can the government, healthcare industry and healthcare professionals respond to this? If asked about antibiotics or antibiotic resistance during your medical school interview, you may also find it useful to consider how your knowledge of this topic would shape your future practice. 

As well as focusing on antibiotic use (‘overuse and misuse’), the WHO places responsibility on policy makers and health professionals to ‘reduce the impact and limit the spread of resistance’. The following resources will support you to begin researching what steps are being taken to achieve this:

From an ethical standpoint, doctors have a responsibility, when prescribing drugs, to ensure that they have ‘adequate knowledge of the patient’s health and are satisfied that the drugs [...] serve the patient’s needs’. They also must ‘provide effective treatments based on the best available evidence’.

Further research

To support you to discuss this topic, it’s essential that you have a clear understanding of antibiotic and antimicrobial resistance and the issues these cause. Knowledge of policies, guidance and public health campaigns, as well as your responsibilities as a future doctor (including the GMC ethical guidance), in relation to antibiotics and reducing antibiotic / antimicrobial resistance will also support your discussions and enable you to effectively answer questions. 

To further your knowledge of the topic, you may also want to explore the following:

Different types of antibiotics

This does not have to be in great depth, but having an understanding of the different types of antibiotics will demonstrate some scientific and medical knowledge, as well as your interest in the subjects. The NHS website provides some general information relating to how antibiotics are classified; although brief, this provides an easy to read overview, and may be a good starting point before carrying out further research if required.

The NHS website also provides additional information about considerations before taking antibiotics, common side effects and how antibiotics interact with other medication or substances, which may be useful for your general understanding of the topic.  

Medical articles

As always, engaging with medical articles will deepen your understanding and provide a critical element to your discussions, which will demonstrate your interest and knowledge of medical topics during your interview. You may find the following useful starting points:

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