When I read the articles by Dr Rob Wicks and Dr Tim Harlow (December 1998) on antibiotics guidelines, I recognised the problems they described and read their words with interest, picking out things I could apply to my own practice.

I would like to ask Tim Harlow what he came up with on the length of antibiotic courses for tonsillitis. In our practice, we all treat tonsillitis with a week's course of antibiotics – most other infections get three- or five-day courses. When we checked the reason for this, all we could find was an old paper on the treatment of American GIs.

We wonder whether tonsillitis too should get shorter antibiotic courses. Did he find something we missed?

Dr M Lockyer GP, Suffolk

Dr Harlow replies:

We understood from local microbiologists that 10 days' treatment was needed to eradicate Streptococcus pyogenes from the throat. As we hoped to be dealing with fewer (and thus sicker) patients, we felt the longer courses would be sensible.

The literature seemed to assume that the gold standard was 10 days, although there were reports of shorter courses being successfully compared with this. Evidence, other than anecdotal, that 10 days' treatment was needed was sparse, and we therefore allowed a spread of course length.

Dr T Harlow GP, Devon

You may be interested in an initiative that we are undertaking in North Derbyshire to try to reduce the inappropriate use of antibiotics.

Two recent national reports (House of Lords Select Committee and SMAC) recommend a strategy to reduce the use of antibiotics which includes education directed at doctors and patients, and the use of local antibiotic formularies/guidelines.

Our Antibiotic Support Pack has recently been sent to all GPs. This contains our Antimicrobial Treatment Guidelines, together with the evidence, in the form of an educational resource, and a do-it-yourself PGEA pack.

It also includes a poster for display in the surgery and a choice of three patient leaflets which can be used in a consultation and given to patients instead of a prescription.

We have also sent the support packs to all community pharmacists and encouraged them to liaise with local doctors and provide consistent messages to the public which will reduce their expectations. We hope they will use the patient information leaflets when people present with symptoms of cough, cold, etc.

Peter Burrill, Pharmaceutical Adviser, North Derbyshire HA

Guidelines in Practice, January/February 1999, Volume 2
© 1999 MGP Ltd
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