Antibiotic Request

Management

This is a sensitive case focused on reassuring and guiding a very concerned parent. It also highlights the risks of relying on internet advice for medical information.

To help her feel more at ease, start by addressing her main concerns.

1. First, she worries that another cold or cough could turn into something life-threatening without antibiotics—a belief shaped by what she’s read online. Reassuring her that most coughs and colds are caused by viruses, like bronchiolitis, and will get better on their own can help ease her fears. Explaining that antibiotics wouldn’t have prevented Jenny’s hospital stay may help her understand why they aren’t needed here.

2. Second, she’s anxious about accessing healthcare abroad, which is understandable when travelling somewhere unfamiliar. Suggesting that she contact the hotel or her travel insurance provider to find out about local medical services can help her feel more prepared and confident for the trip.

The legalities of prescribing ‘just in case’ medication.

Guidelines published by the General Practice Committee (GPC) back in 2013 state that: “For drugs which are being issued solely in anticipation of the onset of an ailment whilst outside the UK, but for which the patient does not require treatment when the medicine is prescribed”, can be prescribed, but must be a private prescription. They go on to stipulate that “Any doctor can write a private prescription for a patient if they feel it is clinically appropriate and they are happy to take responsibility for that prescribing decision.”

This latter sentence is very important. The GMC expand on this stating:

GMC on prescribing:

1. Doctors are responsible for the prescriptions that they sign and should be prepared to justify any decision to prescribe.

2. Doctors do not have to prescribe treatments that they do not consider to be of overall benefit to patients, even if patients ask for such treatments. However, they should discuss the request with the patient, explain their reasons and advise the patient of their right to seek a second opinion.

3. Doctors should, together with the patient, make an assessment of their condition before deciding to prescribe a medicine.

4. Doctors should explain to patients the likely benefits and risks of treatments, including side effects.

5. Advice should include how to take the medicine and how to adjust the dose.

6. Doctors are responsible for the safe monitoring of medication, including blood tests. If doctors prescribe for patients who are overseas, they should consider how the condition may be safely monitored. They should also consider whether they have appropriate professional protection to treat patients overseas.

Expanding further on this, the advice from Medical Protection services stipulates that doctors should be aware of the risks of prescribing “just in case” medication – as it would be safer and preferable for the patient to seek medical review if they become unwell abroad. We could therefore surmise, that It might be difficult to justify prescribing “just in case” antibiotics in this case, as if the baby came to harm abroad, the prescribing Doctor would not have been able to make an adequate assessment at the time, and would have no way of knowing if antibiotics was the right course of action.

An Example

Here’s an experience that highlights the importance of following medical guidelines. A middle-aged patient, prone to diverticulitis and often needing antibiotics, requested a "just in case" prescription before going on an overseas trip. In line with best practices, the request was declined.

While abroad, the patient developed stomach pains and sought local medical help. The doctor recommended hospitalisation, but the patient, feeling upset at this advice (and under the impression that antibiotics were all that was needed for their “diverticulitis”), asked the doctor to call her GP practice back home to discuss the advice. Upon consultation, the GP upheld the local clinician's recommendation.

Despite the patient’s reluctance, they were ultimately admitted, where it was discovered they had a ruptured colon and a significant abscess, requiring surgery and intensive care. This case illustrates the potential risks of taking antibiotics without a thorough medical evaluation. If they’d had antibiotics on hand, they might have taken them instead of seeking the medical attention they urgently needed.

This scenario serves as a reminder of the crucial role that adherence to medical guidelines plays in ensuring patient safety.

Conclusion

To conclude, it would not be considered good practice to prescribe ‘just in case’ antibiotics for this baby. This may not apply to every situation however, in other circumstances, it might be different - for example, a patient with long-standing COPD, who has “rescue antibiotics and steroids” at home. For those individuals, who understand their condition, and know when to take their medication, prescribing “just in case” antibiotics and steroids would be more justifiable, and likely appropriate.