Doctor, I just need you to prescribe me an antibiotic…

By Dra Maria Alice [email protected]

Dr Maria Alice is a consultant in General and Family Medicine and is director of Luzdoc International Medical Service in Praia da Luz, Lagos.

This was said in a very polite, but also very determined and demanding voice, by a very nice gentleman … or a very nice lady … or even a not less nice mother or father sitting on the other side of the desk. Well, well, well, here we go again.

Doc: Do you know exactly what you would need to take?

Client: Yes, I do. It is ****. A friend of mine told me he had it for something similar to the symptoms I have now. I also had it some time ago when I had a bad cold and it worked very well. I tried going to the pharmacy but they would not sell it to me without a prescription. 

Doc: And why do you think they said that?

Client: They said a doctor has to write it…

Fine, let’s try to explain.

OK! The pharmacist is acting correctly as in Portugal there are lists for “over the counter” and for “prescription” drugs.  

A prescription medication is a licensed medicine that is regulated by legislation to require a medical prescription before it can be obtained.

The term is used to distinguish it from over-the-counter drugs which can be obtained without a prescription.

As a general rule, over-the-counter drugs are used to treat conditions not necessarily requiring care from a health care professional.

Thus the need to see a doctor or, more precisely, for a doctor to see the patient before prescribing, as “prescribing” anything to a patient is the direct consequence of the medical assessment and the doctor’s decision on what that specific patient needs to be treated with in those circumstances.

The act of prescribing is an enormous responsibility, it is difficult and dangerous. The choice needs to be accurate and based on the actual “state of the art” of the medical profession.

The moment a doctor writes a prescription, the fact that a person is going to take it becomes the doctor’s, and only the doctor’s, responsibility.

Whatever bad consequences might arise are the doctor’s legal and personal responsibility. That is why we doctors need to see the patients before prescribing.

Antibiotics do not work against viruses

Taking an antibiotic when you have a viral infection will not make you feel better and can contribute to antibiotic resistance.

Antibiotics are effective against bacterial infections, certain fungal infections and some kinds of parasites.

Besides the clinical observation, there are blood tests that can be done to have a more correct idea if the disease is viral or bacterial.

This has been a great help for the doctors who have these tests available at their clinics, with immediate results, to be able to treat their patients more accurately.

Antibiotic misuse puts you and others at risk

Antibiotics can be lifesavers, but misuse has increased the number of drug-resistant germs.

Antibiotic resistance occurs when antibiotics no longer work against disease-causing bacteria. These infections are difficult to treat and can mean longer lasting illnesses, more doctor visits or extended hospital stays, and the need for more expensive and toxic medications. Some resistant infections can even cause death.

Although experts are working to develop new antibiotics and other treatments to keep pace with antibiotic-resistant strains of bacteria, infectious organisms adapt quickly.

Antibiotic-resistant bacteria will continue to be a global health concern and using antibiotics wisely is important for preventing their spread.

If antibiotics are used too often for things they cannot treat, like colds, flu or other viral infections, they become less effective against the bacteria they are intended to treat.

The failure of first line antibiotics also means that doctors have to resort to less conventional medications, many of which are more costly and associated with more serious side effects.

Safeguarding antibiotic effectiveness:

• Understand when antibiotics should be used. Don’t expect to take antibiotics every time you’re sick.

• Do not pressure your doctor for antibiotics. Talk with your doctor and trust his/her judgment. That is what doctors study for!

• Take antibiotics exactly as prescribed. Follow instructions to the letter. Do not stop treatment a few days early because you are feeling better. Taking the full course of antibiotics is the only way to kill all of the harmful bacteria. A shortened course of antibiotics, on the other hand, often wipes out only the most vulnerable bacteria, while allowing relatively resistant bacteria to survive.

• Never take antibiotics without a prescription. If you did not complete a full course of antibiotics, you might be tempted to use the leftover medication the next time you get sick or to pass it along to someone else. This is not a good idea at all!  That antibiotic might not be appropriate for a future illness and even if it is, there will not be enough pills for a proper full treatment, leading to more resistant bacteria.

• Antibacterial cleaners and soap. They are not necessary. Plain soap and water work fine.

Antibiotic resistance is a global health problem. Nearly all significant bacterial infections in the world are becoming resistant to commonly used antibiotics.

When you misuse antibiotics, you help create resistant microorganisms that can cause new and hard-to-treat infections.

That is why the decisions made about using antibiotics have far-reaching consequences. Be responsible in how you use antibiotics to protect your health and that of your family, neighbours and community.

Sorry if I am stating things that you all probably already know about. But the fact is, it seems that quite a few people, when they are ill, forget this. I know that all they want is to get better quickly but, unfortunately, antibiotics do not always have that effect as they do not cure everything.

Best healthy wishes, Dr. Maria Alice

Consultant in General and Family Medicine

General Manager/Medical Director – Luzdoc International Medical Service

Medical Director – Grupo Hospital Particular do Algarve