Actinomycosis – what are the signs and symptoms of actinomycosis?



Actinomycosis is a rare type of bacterial infection caused by a group of bacteria called actinomycetaceae.

Most bacterial infections are confined to one part of the body because the bacteria are unable to penetrate the body’s tissue.

However, actinomycosis is unusual in that the infection is able to move slowly but steadily through body tissue.

Symptoms of actinomycosis vary depending on the type of infection, but can include:

  • swelling and inflammation of affected tissue
  • tissue damage that results in scar tissue
  • formation of abscesses (pus-filled swellings)
  • small holes or tunnels that develop in tissue and leak a type of lumpy pus

Read more about the symptoms of actinomycosis.

Types of actinomycosis

In theory, actinomycosis can develop almost anywhere inside the tissue of the human body. But the condition tends to affect certain areas of the body and can be classified into four main types.

They are:

  • oral cervicofacial actinomycosis
  • thoracic actinomycosis
  • abdominal actinomycosis
  • pelvic actinomycosis

These are described below.

Oral cervicofacial actinomycosis

Oral cervicofacial actinomycosis is where the infection develops inside the neck, jaw or mouth. In the past, if the condition developed in the jaw it was known as lumpy jaw.

Most cases of oral cervicofacial actinomycosis are caused by dental problems, such as tooth decay or a jaw injury.

Oral cervicofacial actinomycosis is the most common type of actinomycosis, accounting for 50-70% of all cases.

Thoracic actinomycosis

Thoracic actinomycosis is where the infection develops inside the lungs or associated airways.

Most cases of thoracic actinomycosis are thought to be caused by people accidentally inhaling droplets of contaminated fluid into their lungs.

Thoracic actinomycosis accounts for an estimated 15-20% of cases.

Abdominal actinomycosis

Abdominal actinomycosis is where the infection develops inside the abdomen (tummy).

This type of actinomycosis can have a range of potential causes. It can develop as a secondary complication of a more common infection, such as appendicitis, or after accidentally swallowing a foreign object, such as a chicken bone.

Abdominal actinomycosis accounts for an estimated 20% of all cases.

Pelvic actinomycosis

Pelvic actinomycosis is where the infection develops inside the pelvis.

It usually only occurs in women because most cases are caused when the actinomyces bacteria are spread from the female genitals into the pelvis.

Most cases of pelvic actinomycosis are thought to be associated with the long-term use of an intrauterine device (IUD). This type of contraceptive is often known as the coil.

Pelvic actinomycosis usually only occurs if the coil is left in for longer than the manufacturer recommends.

Pelvic actinomycosis accounts for an estimated 10% of all cases.

What causes actinomycosis?

Actinomycosis is caused by a family of bacteria known as actinomycetaceae. In most cases, the bacteria live harmlessly on the lining of the mouth, throat, digestive system and vagina (in women).

The bacteria only pose a problem if the tissue lining becomes damaged by injury or disease, allowing the bacteria to penetrate deeper into the body.

This is potentially serious because these are anaerobic bacteria, which means they thrive in parts of the body where there isn’t much oxygen, such as deep inside body tissues.

However, an advantage of actinomyces bacteria being anaerobic is that they can’t survive outside the human body. This means that actinomycosis isn’t a contagious condition.

Read more about the causes of actinomycosis.

Diagnosing actinomycosis

In its initial stages, actinomycosis can be a challenging condition to diagnose correctly because it shares symptoms with other more common conditions. It’s often only discovered during tests or surgery to check for other conditions.

For example, many cases of actinomycosis are detected when biopsies are carried out to check for cancer. A biopsy is where a small tissue sample is removed so it can be examined under a microscope.

Actinomycosis can usually be more confidently diagnosed in its later stages, after the sinus tracts have appeared in the surface of the skin.

This is because the sulphur granules produced by the sinus tracts during an actinomycosis infection have a distinctive shape that can be identified under a microscope.

Treating actinomycosis

Actinomycosis usually responds well to treatment, which involves taking a long-term course of antibiotics.


An initial course of antibiotic injections is usually recommended for 2 to 6 weeks, followed by antibiotic tablets for another 6 to 12 months.

A nurse should be able to teach you how to administer antibiotic injections at home so you don’t need to stay in hospital for the duration of the course.

The preferred antibiotics for treating actinomycosis are benzylpenicillin, which is used for the antibiotic injections, and amoxicillin tablets.

In some cases, other bacteria are also present and more than one antibiotic or other antibiotics will need to be given.

Side effects of these antibiotics include:

  • diarrhoea
  • nausea (feeling sick)
  • skin rash
  • increased vulnerability to fungal infections, such as oral thrush (a fungal infection that occurs in the mouth)

If you’re allergic to penicillin, alternative antibiotics such as tetracycline or erythromycin can be used.

Read more about antibiotics.


In some cases, minor surgery may be required to repair the damaged tissue and drain pus out of the abscesses.

Complications of actinomycosis

Abscesses that develop as a result of actinomycosis may form in many parts of your body, including your lungs. They can spread easily from one part of your body to another.

If the original site of the infection is located in the skin of your face, it may spread to nearby parts of your body, such as your scalp or ears.

If the original site of the infection is your mouth, it may spread to your tongue, larynx (voicebox), trachea (windpipe) and salivary glands, and the tubes that connect your throat to your nose.

If the infection spreads to your brain, a brain abscess could develop.

Preventing actinomycosis

Most cases of oral actinomycosis occur as a result of poor dental hygiene. This means practising good dental hygiene is the best way to prevent actinomycosis.

Read about preventing tooth decay and dental health for more information and advice about good oral hygiene practices.

[Original article on NHS Choices website]

Abdominal pain – what are the signs, symptoms, cause and treatments of a stomach ache

A stomach ache is a term often used to refer to cramps or a dull ache in the tummy (abdomen). It’s usually short-lived and is often not serious.

Stomach ache and abdominal pain - your guide
Stomach ache and abdominal pain – your guide

Severe abdominal pain is a greater cause for concern. If it starts suddenly and unexpectedly, it should be regarded as a medical emergency, especially if the pain is concentrated in a particular area.

Call your GP as soon as possible or go to your nearest hospital accident and emergency (A&E) department if this is the case.

If you feel pain in the area around your ribs, read about chest pain for information and advice.

Stomach cramps with bloating

Stomach cramps with bloating are often caused by trapped wind. This is a very common problem that can be embarrassing, but is easily dealt with. Your chemist will be able to recommend a product which can be bought over the counter to treat the problem.

Sudden stomach cramps with diarrhoea

If your stomach cramps have started recently and you also have diarrhoea, the cause may be a tummy bug (gastroenteritis). This means you have a viral or bacterial infection of the stomach and bowel, which should get better without treatment after a few days.

Gastroenteritis may be caused by coming into close contact with someone who’s infected, or by eating contaminated food (food poisoning).

If you have repeated bouts of stomach cramps and diarrhoea, you may have a long-term condition, such as irritable bowel syndrome.

Sudden severe abdominal pain

If you have sudden agonising pain in a particular area of your tummy, call your GP immediately or go to your nearest A&E department. It may be a sign of a serious problem that could rapidly get worse without treatment.

Serious causes of sudden severe abdominal pain include:

appendicitis – the swelling of the appendix (a finger-like pouch connected to the large intestine), which causes agonising pain in the lower right-hand side of your abdomen, and means your appendix will need to be removed
a bleeding or perforated stomach ulcer – a bleeding, open sore in the lining of your stomach or duodenum (the first part of the small intestine)
acute cholecystitis – inflammation of the gallbladder, which is often caused by gallstones; in many cases, your gallbladder will need to be removed
kidney stones – small stones may be passed out in your urine, but larger stones may block the kidney tubes, and you’ll need to go to hospital to have them broken up
diverticulitis – inflammation of the small pouches in the bowel that sometimes requires treatment with antibiotics in hospital

If your GP suspects you have one of these conditions, they may refer you to hospital immediately.

Sudden and severe pain in your abdomen can also sometimes be caused by an infection of the stomach and bowel (gastroenteritis). It may also be caused by a pulled muscle in your abdomen or by an injury.

Long-term or recurring abdominal pain

See your GP if you or your child have persistent or repeated abdominal pain. The cause is often not serious and can be managed.

Possible causes in adults include:

irritable bowel syndrome (IBS) – a common condition that causes bouts of stomach cramps, bloating, diarrhoea or constipation; the pain is often relieved when you go to the toilet
inflammatory bowel disease (IBD) – long-term conditions that involve inflammation of the gut, including Crohn’s disease and ulcerative colitis
a urinary tract infection that keeps returning – in these cases, you will usually also experience a burning sensation when you urinate
period pain – painful muscle cramps in women that are linked to the menstrual cycle
other stomach-related problems – such as a stomach ulcer, heartburn and acid reflux, or gastritis (inflammation of the stomach lining)

Possible causes in children include:

a urinary tract infection that keeps returning
heartburn and acid reflux
abdominal migraines – recurrent episodes of abdominal pain with no identifiable cause


[Original article on NHS Choices website]

Child mortality rates plunge by more than half since 1990 but global MDG target missed by wide margin

16,000 children under 5 years old die each day

Child mortality rates have plummeted to less than half of what they were in 1990,

Child mortality rates
Child mortality rates

according to a new report released today. Under-five deaths have dropped from 12.7 million per year in 1990 to 5.9 million in 2015. This is the first year the figure has gone below the 6 million mark.

New estimates in Levels and Trends in Child Mortality Report 2015 released by UNICEF, the World Health Organization, the World Bank Group, and the Population Division of UNDESA, indicate that although the global progress has been substantial, 16,000 children under five still die every day. And the 53 per cent drop in under-five mortality is not enough to meet the Millennium Development Goal of a two-thirds reduction between 1990 and 2015.

“We have to acknowledge tremendous global progress, especially since 2000 when many countries have tripled the rate of reduction of under-five mortality,” said UNICEF Deputy Executive Director Geeta Rao Gupta. “But the far too large number of children still dying from preventable causes before their fifth birthday – and indeed within their first month of life – should impel us to redouble our efforts to do what we know needs to be done. We cannot continue to fail them.”

The report notes that the biggest challenge remains in the period at or around birth. A massive 45 per cent of under-five deaths occur in the neonatal period – the first 28 days of life. Prematurity, pneumonia, complications during labour and delivery, diarrhoea, sepsis, and malaria are leading causes of deaths of children under 5 years old. Nearly half of all under-five deaths are associated with undernutrition.

However, most child deaths are easily preventable by proven and readily available interventions. The rate of reduction of child mortality can speed up considerably by concentrating on regions with the highest levels – sub-Saharan Africa and Southern Asia – and ensuring a targeted focus on newborns.

“We know how to prevent unnecessary newborn mortality. Quality care around the time of childbirth including simple affordable steps like ensuring early skin-to-skin contact, exclusive breastfeeding and extra care for small and sick babies can save thousands of lives every year,”  noted Dr Flavia Bustreo, Assistant Director General at WHO. “The Global Strategy for Women’s, Children’s and Adolescents’ Health, to be launched at the UN General Assembly this month, will be a major catalyst for giving all newborns the best chance at a healthy start in life.”

The report highlights that a child’s chance of survival is still vastly different based on where he or she is born. Sub-Saharan Africa has the highest under-five mortality rate in the world with 1 child in 12 dying before his or her fifth birthday – more than 12 times higher than the 1 in 147 average in high-income countries. In 2000-2015, the region has overall accelerated its annual rate of reduction of under-five mortality to about two and a half times what it was in 1990-2000. Despite low incomes, Eritrea, Ethiopia, Liberia, Madagascar, Malawi, Mozambique, Niger, Rwanda, Uganda, and Tanzania have all met the MDG target.

Sub-Saharan Africa as a whole, however, continues to confront the immense challenge of a burgeoning under-five population – projected to increase by almost 30 per cent in the next 15 years – coupled with persistent poverty in many countries.

“This new report confirms a key finding of the 2015 Revision of the World Population Prospects on the remarkable decline in child mortality globally during the 15-year MDG era,” said UN Under-Secretary-General for Economic and Social Affairs Mr. Wu Hongbo. “Rapid improvements since 2000 have saved the lives of millions of children. However, this progress will need to continue and even accelerate further, especially in high-mortality countries of sub-Saharan Africa, if we are to reach the proposed child survival target of the 2030 Agenda for Sustainable Development.”

“Many countries have made extraordinary progress in cutting their child mortality rates. However, we still have much to do before 2030 to ensure that all women and children have access to the care they need,” said Dr Tim Evans, Senior Director of Health, Nutrition and Population at the World Bank Group. “The recently launched Global Financing Facility in Support of Every Woman Every Child with its focus on smarter, scaled and sustainable financing will help countries deliver essential health services and accelerate reductions in child mortality.”

Among the report’s findings:

  • Roughly one-third of the world’s countries – 62 in all – have actually met the MDG target to reduce under-five mortality by two-thirds, while another 74 have reduced rates by at least half.
  • The world as a whole has been accelerating progress in reducing under-five mortality – its annual rate of reduction increased from 1.8 per cent in 1990-2000 to 3.9 per cent in 2000-2015.
  • 10 of the 12 low income countries which have reduced under-five mortality rates by at least two-thirds are in Africa.
  • 5 in 10 global under-five deaths occur in sub-Saharan Africa and another 3 in 10 occur in Southern Asia.
  • 45 per cent of all under-five deaths happen during the first 28 days of life. 1 million neonatal deaths occur on the day of birth, and close to 2 million children die in the first week of life.

Just been diagnosed with Celiac disease? Here’s what you need to know!

As you may know last month (May) was Celiac Awareness Month. To help promote this event we published a FAQ based upon an interview with Dr Chris Steele. Steele is both a doctor and a person who lives with Celiac disease.

As part of our preparations for this interview we asked a patient who has been diagnosed with gluten

Celiac Awareness
Celiac Awareness
intolerance and probable Celiac what were the first questions he wanted to know the answers to as soon as he was diagnosed. And we are now delighted to share the results of this interview with you today!

It might be worth mentioning that in Dr Steele’s native UK the condition is spelt Coeliac rather than Celiac. This might explain some of the idiosyncratic spelling in this follow up.

Also you might find this introduction to Celiac disease of use and interest.

Patient Talk: If we can just talk a bit about how this might affect any who has coeliac disease or gluten intolerance, what would happen if someone inadvertently ate food containing gluten, how careful do they have to be?

Dr. Chris: Some people have to be very careful. Like most disease there is a spectrum, it can be mild it can be moderate it can be severe. And some patients with very sensitive intestines who react to tiny amounts of gluten, a classic example is a coeliac patient has to have their own toaster. Because if they put their gluten free bread in to the family toaster, which is ordinary bread, even crumbs from ordinary bread can set off their symptoms of diarrhoea, the abdominal pain and bloating. There are some patients which are less severe and they tolerate little gluten and you soon find out where you stand on the spectrum.

Patient Talk: there’s a question here: Is it safe to buy food which is not labelled as gluten free of is there is no gluten items in the ingredients?

Dr. Chris: I think what you have to think about is where gluten can be? It’s in the bread, pasta, pastries, cakes. But it’s also hidden in foods like sausages, fish fingers, soups sauces, soy sauce, and beer. Right?

Patient Talk: Right.

Dr. Chris: You’ve got to be aware. I think a good thing is if you go to Coeliac UK they give you some very good directory of all the foods and drinks out there and the levels of gluten in them.

Patient Talk: Does that cover gluten free friendly restaurants?

Dr. Chris: Now this is a problem when you go out to eat. A restaurant might advertise this gluten free food. Yeah they are probably serving normal good and gluten free food as your gluten free food has been on the surface on kitchen where there was normal food before and therefore there can be contaminated. There are some restaurants which are totally gluten free and more and more of them are popping up and you can go in and feel quite reassured when you go in and normally the chief or the owner is a coeliac.

Patient Talk: This one is an interesting question as well, can somebody kiss their partner if they are a coeliac and their partner has eaten bread?

Dr. Chris: I think it’s very unlikely, unless they have a thick coating of bread crumbs on their lips.

Patient Talk: So is it safe to touch and handle bread?

Dr. Chris: Not normal bread, if you are touching or handling or even the slight taste of any food which contains gluten you could get a reaction where your symptoms flare up.

Patient Talk: Does the same apply for drinks ?

Dr. Chris: Yep, you just got to be very aware, you know? Of the drinks as you don’t think of them as containing gluten. Barley, wheat, rye, if it’s there it contains gluten.

If you are a Celiac what were you first concerns?

Why not share them and the solutions in the comments section below.

Thanks very much in advance.

Are we too reliant on on antibiotics? Find out in our interview with Dr Martin Duerden.

Dr Martin Duerden
Dr Martin Duerden
When faced with a cold or sore throat are we too ready to reach for antibiotics as a prefered treatment? What are the alternatives? How effective are they?

PatientTalk.Org interviewed Dr Martin Duerden , a UK based primary care physician, university lecturer, and Clinical Advisor in prescribing for the UK Royal College of General Practitioners.

PATIENTTALK.ORG- It is estimated that 1.6 million unnecessarily antibiotic prescriptions are issued each year in the UK. This survey of pharmacy staff sees the vast majority say there needs to be improved awareness of unnecessarily antibiotic use especially in upper respiratory tract infections such as sore throats and colds. So Dr Martin what do antibiotics actually do?

DR DUERDEN- Well antibiotics are drugs that either kill bacteria or stop them multiplying and bacteria can invade your body and they help to prevent that happening. They have to be used alongside your immune system and generally people who are fit and healthy antibiotics aren’t necessary for most types of infections because your immune system deals with those infections. What this survey n showed was that for things like respiratory tract infections sore throats, coughs and colds, there really isn’t a need to go see your GP and 90% of the pharmacy staff questioned felt that patients were going along to their GP or felt that they needed antibiotics when those weren’t necessary.

The reason why they are not necessary is because they are caused by viruses and viruses do not respond to antibiotic. It makes no difference. Sometimes you get secondary infections related to the virus and that’s where antibiotics sometimes have a place but for the vast majority of coughs, colds and sore throats there’s no need to have an antibiotic. The problem is we have got used to having them. We tend to go see our GP. We tend to expect them and the GP unfortunately finds it very difficult, sometimes the only way, the best way, well they feel the easier way deal with it is to issue a prescription but that is the wrong way.

PATIENTTALK.ORG- Is there really a risk of superbugs?

DR DUERDEN- It’s a real risk and that is part of the message we are trying to get across. Today is European Antibiotic Awareness Day and what we are trying to raise is that we must campaign against unnecessary antibiotic use and the reason for that is because the more antibiotics we use the more bacteria becomes resistant to those drugs. Bacteria are very clever things and they develop resistance and we over use them we are going to run out of them and if we run out of them then simple things that we thought were curable will no longer be curable things like pneumonia, things like meningitis, will have to change the way we do modern medicine. So people won’t be able to have hip operations or knee operation. They might not be able to have chemotherapy for cancer. They may not be able to have organ transplants simply because we won’t have an antibiotic to use in that context. This is a real threat we really do have to stop unnecessary use and conserve the antibiotics we have got so they don’t develop antibiotic resistance.

PATIENTTALK.ORG- How effective are antibiotics against infections like MRSA?

DR DUERDEN- At the moment we are quite lucky that we can treat a lot of MRSA. That is Methicillin-resistant Staphylococcus aureus or Multiple Staphylococcus. MRSA in the UK has become less of an issue in the last decade or so because we have developed very good techniques for infection control processes within hospitals. That is rigorous attention to washing your hands and keeping things as clean as possible. Now the catch is if we do have to treat those bugs at the moment we have to use drugs that themselves are unusual, last resort drugs they tend to have toxic effects and they can be problematic. The problem is that MRSA indicates those bugs that used to respond to simple penicillin antibiotics no longer respond to those simple antibiotics we have to use to those more difficult ones. There is another point there that the reason that resistance is such a challenge is that we are running out of antibiotics. No new classes of antibiotics have been developed in the last couple of decades and if we don’t have new antibiotics coming along then sooner or later these new infections will become really troublesome.

PATIENTTALK.ORG- What are the alternatives to antibiotics and how would they work?

DR DUERDEN- Well the main place for using those alternatives is when you have self-limiting cough or cold or sore throat and they are highly effective. They are much more effective than antibiotics which really make no difference in that context so for the vast majority of people who are relatively healthy if they have got a cough or a cold or a sore throat they really should treat themselves or go to their pharmacy and get interventions that can be used to relieve their symptoms. They should not think they need an antibiotic. If they think they need advice on how best to manage the problem then they should go to their community pharmacist who can advise them what systemic interventions can be used but they can also advise them in the very unusual instances where they might need to go and see their doctor. They will direct them to their doctor and I think that is a much better to deal with this issue. So the alternatives are things like pain killers which will levitate the aches and pains of having a cough, cold or sore throat. It will also help reduce the fever and you can also use things like cough medicines and anti-septic lozenges are very good at soothing a sore throat so those very simple interventions are much better than thinking or believing an antibiotic is necessary. Antibiotics don’t work. They cause side effects in those instances and they should only be used if they are strictly necessary.

PATIENTTALK.ORG- So as it stands why is the medical profession so poor at providing alternatives?

DR DUERDEN- I think that is a really complicated issue and its developed over several decades really since antibiotics first came along in 1950 and at that time antibiotics were lifesaving and there was this real view that antibiotics had a really important place and they did at that stage but as time has gone along we’ve become almost dependent on them since we rely on antibiotics. In most instances they are not necessary so patient experience has been that when they have these problems they get an antibiotic. Patients also believe that there should be a cure for all ill’s and modern medicine seems to suggest that might be the case but the problem is viruses do not respond to that treatment and there isn’t any treatment that will help to affect the virus and when patients turn up at the GP surgery, GP’s are going to be very busy. They tend to be nice people. They don’t like confronting their patients and they tend to be rather cautious. It seems reasonable to give a patient any antibiotic in that instance and in the past it’s been felt that antibiotics are harmless but antibiotics are not harmless. The reasons I’ve just described they cause resistance and if we give an antibiotic to one person then we are scuppering the chances of treating future people so it’s really important that message gets across. Also, antibiotics, if you give them to people with self-limiting conditions they cause more harm than benefits. They cause things like diarrhoea. They can cause nausea and vomiting. They can cause a rash and adverse effects can be more troublesome so they are not harmless and we really need to change both what GP’s do in terms of prescribing them but how patients and the public if you like, relate to antibiotics. They should not see them as something that can be used for self-limiting infections. In general they have to be preserved for severe infections and for times when antibiotics are strictly necessary.

PATIENTTALK.ORG- Do you think Med Ed could play a role?

DR DUERDEN- I think it’s really important, Medical Education is all part of this and certainly there is quite a lot of evidence. There was a good research project and published paper from Cardiff University a few years ago which showed that you can improve the ways that GP’s communicate with patients and provide the right kind of information to patients to help make a decision not to use antibiotics and to avoid confrontation and so I think there is a lot of work that needs to be done with prescribers to improve our understanding of antibiotics but also to improve our communication of the risks and benefits of using antibiotics. I think there is also a really important role for education with pharmacy staff as well although pharmacy staff are generally well trained but we can provide things like decision aids information for community pharmacists which they themselves can use with patients to help convey some of the problems that I’ve been describing to you.

PATIENTTALK.ORG- Regarding the research what methodology was used?

DR DUERDEN- Well it was simple survey of pharmacy staff. Two thirds of the people questioned, and they were 143 pharmacy staff questioned, two thirds of those people were pharmacists and basically it was asking them their opinion of antibiotic was and how they should be used. It was clear from that research that they felt the understanding of antibiotic resistance and overuse of antibiotics had not really got across to the general public and we needed to improve on that. They strongly believed, 58% of those asked, felt we should always try systemic treatments before using antibiotics. Pharmacists themselves are well switched onto this message and really do need to harness their role within this conundrum so the message is that as much as possible most patients do not need to go see their GP or their out of hours service or their A&E department. What they should be doing is either treating themselves, maybe reading up on information from things like the internet. NHS Choices have some fantastic information. If they feel that they need further advice they should go talk to their pharmacist and the pharmacist can always advise if necessary that the patient then goes and see the GP but you shouldn’t go straight to your GP with these problems. We all have coughs and colds we know they get better. We know we shouldn’t be expecting a quick fix.


The interview took part on European Antibiotic Awareness Day.

• It is estimated that 1.6 million unnecessary antibiotic prescriptions are issued each year in the UK2
• Survey of pharmacy staff sees vast majority say there needs to be improved awareness of unnecessary antibiotic use especially in relation to upper respiratory tract infections (URTIs) such as sore throats and colds 1
• Over a third (35%) of those surveyed claim the majority of their customers seek antibiotics as a ‘go to’ treatment for URTIs before seeking advice from their pharmacy 1
More than 90% of pharmacy staff questioned believe there is a need for improved awareness of unnecessary antibiotic use 1

That’s according to new research which also saw over half (59%) say alternative options for symptomatic relief of upper respiratory tract infections (URTIs), such as sore throats and cold and flu, should always be tried before antibiotics. 1

Despite this, only a third (38%) of the pharmacy staff talk to their customers about alternative options for symptomatic relief for URTIs.1

It is estimated that 1.6 million unnecessary antibiotic prescriptions are issued each year in the UK.2

For pharmacy staff, recommending non-antibiotic treatment for URTIs is a challenge. Once antibiotics have been prescribed by GPs previously, pharmacy staff understandably find it difficult to convince patients that symptomatic relief is a credible and effective treatment option – and an alternative to antibiotics.

Those surveyed also showed a hesitance in questioning the GP’s assessment, 11% would advise customers that their GP knows best.1 Many patients also see antibiotics as the best solution: over a third (35%) of those surveyed claim the majority of their customers seek antibiotics as a ‘go to’ treatment for URTIs before seeking advice from their pharmacy.1

In the majority of patients, URTIs are of viral aetiology and do not benefit from antibiotics. According to Global Respiratory Infection Partnership (GRIP), antibiotics will not relieve the symptoms of most colds, sore throats, earaches or coughs. In most cases symptomatic treatments are effective and more appropriate at providing symptomatic relief.

1. Survey of 143 pharmacy staff. One in three respondents work in a single shop independent or a small chain of five or fewer branches. Strategic Development Resources Ltd. October 2014
2. Professor Dame Sally Davies. Antimicrobial resistance – why the irresponsible use of antibiotics in agriculture must stop, 2014
3. Arroll B, Kenealy T. Cochrane Database Syst Rev. 2005;(3) CD000247.
4. Van Gageldonk-Lafeber AB, et al. Clin Infect Dis. 2005;41:490–497.
5. Hildreth CJ, et al. JAMA. 2009;302:816.
6. NICE Clinical Guideline 69. 2008. Accessed 02 April 2013. Link: P13
7. Benrijom SL et al. Clin Drug Invest 2001;21:183-93