antibiotics

Posted on December 11, 2018December 11, 2018 Autism

Baylor study aims to find out why some children’s autism symptoms improve with antibiotics

How antibiotic resistance spreads

Over the Thanksgiving holiday in 2012, John Rodakis, a father of a child with autism, observed his son’s condition dramatically improve while taking a common antibiotic. This marked the beginning of a four year quest to understand how an antibiotic might affect behaviors associated with autism. Today, on the four year anniversary of that observation, Baylor College of Medicine is launching a national study funded by the non-profit the father started, N of One: Autism Research Foundation, to investigate this routinely observed phenomenon.

The first-of-its kind study will investigate why some children with autism spectrum disorder (ASD) experience improvements or changes in their autism symptoms when taking antibiotics. The study will follow children over a two-year period and capture information anytime antibiotics are prescribed by their regular physicians and compare changes in the gut microbiome (bacteria, yeasts and fungi found in the gut) and metabolome (small biological molecules produced by the microbes) during antibiotic use of those who experience a change in symptoms during to those who do not. The study seeks to understand when and why these changes occur and how this information can be harnessed for future interventions.

Autism Spectrum Disorder is a neuro-developmental disorder with a steadily growing prevalence that affects more than 2 percent of children. Many parents have reported that their children experienced significant changes in their ASD symptoms, typically improvements, though sometimes a worsening of symptoms, when taking antibiotics, aka the “antibiotic effect.” Recent research has documented abnormalities in the gut microbiome of children with autism. Researchers have speculated that changes in the gut bacteria caused by antibiotics may be behind the changes in symptoms observed in some children with autism. The gut-brain axis is now being widely investigated by researchers in many fields of medicine.

The study marks the first collaboration between N of One: Autism Research Foundation and Baylor College of Medicine and is the brain-child of two parents of affected children, Dr. Ruth Ann Luna and John Rodakis, who have both been investigating the microbiome’s role in autism. Dr. Luna is one of the nation’s leading investigators of the role of the microbiome in autism and is the Director of Medical Metagenomics at the Texas Children’s Microbiome Center at Texas Children’s Hospital in Houston. Dr. Luna is also an Assistant Professor in the Department of Pathology & Immunology at Baylor College of Medicine. Mr. Rodakis is a former medical venture capitalist who founded the N of One: Autism Research Foundation. Both Luna and Rodakis have observed changes in their children’s autism symptoms while taking antibiotics. “Working with Dr. Luna has been very energizing because as a fellow affected parent, we share a real passion to get this right for our children as well as millions of others,” says Rodakis.

“The support of N of One is enabling a much needed study that would have been unlikely to be funded elsewhere. Because we have both witnessed the antibiotic effect in our own children, we knew this was a natural starting point targeting a gap in published autism research. Our goals reach far beyond this first study and include using these initial data to more effectively subtype autism and thereby develop and deliver more effective microbial-based interventions.”

There is a growing recognition that the microbiome plays a role in autism. In 2000, a clinical trial conducted at Chicago Rush Children’s Hospital demonstrated that eight out of 10 children experienced a significant improvement while taking the antibiotic vancomycin. Despite this and numerous reports published in the media and medical literature of children with ASD unexpectedly improving while taking antibiotics, there have been no systematic attempts to investigating this antibiotic effect until now.

“The question of why some children’s autism symptoms improve is important to me scientifically and personally. We saw this in our own child in 2012 and I published a paperdescribing what I saw. Soon, I began hearing from parents all over the world who had observed same thing,” Rodakis says. “It was stunning to me that there was a frequently reported phenomenon of improvement that was not being used as a clue to guide further research. Today we begin that process.”

The phenomenon has parallels to the “fever-effect,” an observation that some children with ASD experience improvements when they had a fever. Parents had been reporting this for decades, but the reports were not followed up on until 2007 when a Johns Hopkins researcher, Dr. Andy Zimmerman, (a scientific advisor to N of One) documented the effect and later in 2014 used the observations as the basis for a successful treatment trial using sulforaphane, a compound found in broccoli. N of One: Autism Research Foundation was also a sponsor of that trial.

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Leave a comment Posted on December 12, 2016December 9, 2016 Skin conditions

Eczema in children: 7 tips to stop the itch

Eczema in children

Eczema in children: 7 tips to stop the itch

[Original article on NHS Choices website]

Dr Colin Holden, consultant dermatologist, has these tips for parents of babies and small children with eczema.

Get an eczema diagnosis

If you think your baby or child has eczema, see your GP to get a proper diagnosis and treatment. If necessary, your child may be referred to a dermatologist.

Don’t try to treat eczema by yourself. Each case can need different treatment, which usually involves a combination of moisturisers (emollients) and steroid creams and ointments.

If their skin becomes red and starts to seep liquid, it may be infected, in which case see your GP immediately for antibiotics.

Give your child a bedtime routine

Children with eczema often find sleeping a problem, as their skin can get hotter and itchier at night. Keep their bedroom cool and use cotton sheets or a light, natural-fibre duvet.

Apply moisturiser at least 20 minutes before bedtime to allow it to soak in. Keep pets out of the bedroom, as dogs and cats can make eczema worse.

Your GP or pharmacist may be able to recommend a suitable sedative antihistamine that may help your child sleep during a particularly bad flare-up of symptoms.

Avoid harsh soaps, shampoos and bath oils

Soap and bubble bath can make eczema far worse, as can washing your child too often.

Bathe your baby in warm - not hot - water, and stick to fragrance-free soaps, shampoo and bath oil. Your pharmacist or GP can advise you on what products to buy.

Use lots of moisturiser

Dry skin is more likely to flare up or become infected with a bacteria or virus. Use moisturising creams on your child as directed by your GP to make sure the skin affected by eczema is kept as soft and moist as possible. Avoiding harsh soaps that dry out the skin will also help.

Help your child to stop scratching

One of the biggest problems with childhood eczema is the urge to scratch the itchy skin, which may then bleed or become infected.

See if your child scratches at certain times of the day, for example while watching TV, and try to teach them to do something else instead, such as tightly holding their arm.

Praise them for not scratching, or even use a star chart. Keep their nails short.

Cotton bandages, vests and/or leggings can help keep the cream in the skin and help prevent your child from scratching.

Check your child's diet

Eczema usually starts when a baby is around six months old. In about 10% of cases it is triggered by foods, including milk, eggs, citrus fruit, chocolate, peanuts and colourings.

If you suspect a food is causing your child's eczema, it's important to seek advice from your GP before you cut out the food to make sure your child still gets a balanced diet.

Read more about food allergy and intolerance.

Keep your child cool

Heat can make the skin itch more, so after your child has been running around or playing sports try to keep them as cool as possible in loose clothing.

If they've been swimming, rinse off any chlorine from the pool, as this can irritate the skin.

Leave a comment Posted on December 1, 2014March 13, 2017 Medical Education, Patient Talk

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

Background

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.

References:
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: http://guidance.nice.org.uk/CG69/NICEGuidance. P13
7. Benrijom SL et al. Clin Drug Invest 2001;21:183-93

Leave a comment Posted on November 20, 2014November 19, 2014 Patient Talk, Public Health

One third of the planet do not have basic sanitation say WHO. Is this a major health threat?

Is basic sanitation a human right?

Years ago I was at a conference having a conversation with a potential client. The conversation moved on from boring market research to rather more interesting topics.

He asked me a very interesting question. Did I know what was the increase in average human lifespan from beginning to end of the Twentieth Century and why?

Well he explained that it was on average 30 years per person. And the two reasons for this he suggested were antibiotics and clean water.

So I was very interested to cast my beady eyes over a report published by the World Health Organisation, published yesterday, The UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water. Granted an uninspiring title but from a worldwide health perspective one of great importance.

I thought I’d share some of the key finds. I don’t suggest you read the stuff WHO have produced because NGOs indulging in self-justification of their own existence in an unedifying sight!

WHO states “2.5 billion men, women and children around the world lack access to basic sanitation services. About 1 billion people continue to practice open defecation. An additional 748 million people do not have ready access to an improved source of drinking-water. And hundreds of millions of people live without clean water and soap to wash their hands, facilitating the spread of diarrhoeal disease, the second leading cause of death among children under five.

Many other water-borne diseases, such as cholera, typhoid and hepatitis, are prone to explosive outbreaks. Poor sanitation and hygiene can also lead to debilitating diseases affecting scores of people in the developing world, like intestinal worms, blinding trachoma and schistosomiasis.”

So we are looking at around one third of our planet’s population which is more than concerning. This is particularly the case in rural areas. They share “While a vast majority of people who lack access to basic sanitation live in rural areas, the bulk of financing continues to benefit urban residents.”

They go on “Investments in water and sanitation yield substantial benefits for human health and development. According (their) estimates, for every dollar invested in water and sanitation, there is a $4.3 return in the form of reduced healthcare costs for individuals and society. Millions of children can be saved from premature death and illness related to malnutrition and water-borne diseases. Adults can live longer and healthier lives”.

All of which may be true but my question is how can we deliver clean water and sanitation to fellow global citizens? It is a serious question and I would be keen to hear your answers in the comments section below.

Many thanks in advance!

Leave a comment Posted on July 11, 2014July 15, 2014 Patient Talk

Millions admit they don’t follow doctor’s advice and instructions when taking medication – Find out more about Pharmacy Voice might help us with compliance!

Medical thought leaders are worried that many of us could be putting their health at risk by not following instructions from

Hamzah Baig of GSK

doctors, nurse, and pharmacists when taking their medications. That’s after new research released this week that shows a quarter of those spoken with have not followed instructions about a course of treatment prescribed by a doctor, while only a 20% always complete a course of medication.

The study also shows that many people don’t believe there is anything wrong with not following instructions to the letter with a quarter believing that a course of treatment does not need to be followed rigidly to get better, and 45% saying they trust their body telling them they feel better more than a prescription course of a treatment.

However, experts say while symptoms can often abate, that doesn’t always mean the patient has sufficiently recovered. There is particular concern over people not finishing courses of antibiotics which can make bugs resistant, presenting danger to not only the patient but also others in the community.

Of further concern is the one in ten surveyed by Pharmacy Voice who admit to taking more than the recommended dosage, while a quarter don’t always use measures when taking liquid medication. One in seven say they have used out of date medicines and one in 20 even use medication which was prescribed to family or friends.

Other findings saw more than 40% admit they keep unused prescribed medicines just in case they need them again, while less than 40% return unused medicine to the pharmacy which is recommended, with a quarter throwing unused medication in the bin or in the toilet.

PatientTalk.Org’s Giles Draper was very kindly given the opportunity to interview Dr Hamzah Baig who is Medical Director at GSK and Raj Patel, a community pharmacist and member of Pharmacy Voice.

GILES: Joining Patient Talk now are Dr Hamzah Baig and Raj Patel. Dr Baig, what are the main barriers to medication compliance from the point of view of both patient and healthcare professional.

DR BAIG As this new research today has shown, one of the main barriers to compliance is the fact that people deliberately don’t follow the instructions about the course of the treatment that they take. For example, only a fifth complete a course of a medication and one in ten have taken more than the recommended dosage and one in seven use out of date medicine, so people aren’t really following the instructions given with their medicines.

MR PATEL Also, patients just don’t remember when and how to take their medicines, they may lead a hectic lifestyle and they just basically forget . That will affect compliance and just stop them from taking their medicines as they need to .Some patients go on holiday and think I’ll just stop taking this antibiotic while I’m on holiday. Or they go out for a drink one evening and they’re in the middle of an antibiotic course and they’ll think, I’ll just stop taking it tonight, have a few drinks and carry on the course the next day .

GILES: Dr Baig, have these patterns of non-compliance changed in anyway?

DR BAIG They haven’t really changed over many years. I think it’s something that both Doctors and pharmacist have been trying to look into to try and improve compliance. Obviously these days we have more digital tools at our means, so you can get apps that help with when you can take your medicine all the way through to some tradition ways of using dosette boxes which are little plastic boxes which have the days of the week and you can take all of your medicines and empty them out and get your full weeks medicine divided up in the right time and days for you. Although these are tips and tricks. I think that quite a lot of education needs to happen to allow people to take the medicines and get the full potential from the medicines.

GILES: Raj, what can be done to improve compliance, any other examples you can give?

MR PATEL I think that another way we can improve compliance amongst patients is to make sure they understand why they are taking their medicines. Here’s an opportunity to use your local community pharmacist to sit down with them talk about the medicines and why they have been prescribed, possible side effects they may encounter and when they need to take those medicines. That will improve compliance because the patient is more knowledgeable.

GILES: Dr Baig, can you just tell us a bit about the risk of not taking prescribed medication and give us some examples?

DR BAIG Well I think that two of the most published examples of the risk of not taking prescribed medication include for example with short term conditions like an infection if you don’t take the full course of the antibiotics you’re at risk of perhaps getting that infection come back or it not being fully treated. With more long term conditions such as asthma for example , you can end up having some terrible affects such as asthma attacks in the future because you haven’t fully controlled your condition with the medicines that you’ve been given.

GILES: Raj would you like to comment on that:

MR PATEL Main risk of noncompliance are patients that are on medicines that if they suffer from heart disease, if they stop taking their cholesterol tablet or if they stop taking their blood pressure tablet they are increasing their risk of a stroke and the repercussions long term of having a stroke, you could end up in a wheelchair and not be able to walk etc. So we need to make sure that patients take the medicines when they need to take them.

GILES: Will the many new social media apps that have appeared help with compliance?

DR BAIG I think that it will help a certain population – perhaps some younger people, people who are a bit more technology aware but you’ve got to remember that the vast majority of treatments are taken by people who are later in life, who may have other problems such as difficulty with hearing, problems with their joints and things like that so I think it may go some of the way to helping people but there’s obviously a lot more we need to do for a lot more people out there.

GILES: Raj,can you tell us what Pharmacy Voice is, and how it can benefit patients?

MR PATEL Pharmacy Voice represents community pharmacy, employers and it represents 11,000 community pharmacies in England. We’re there just to represent community pharmacies and how it can help with patients. I would say that patients that utilise their pharmacies more, that spend time talking with them about any concerns they have about their medicines, talk to them about possible side effects and also when to take the medicines and if they are not sure if they should be taking it with or without food or if they should be taking it last thing at night. The pharmacist is in the best position to give you this advice, we’re health care professionals on the high street, we’re open long hours you don’t need to make an appointment and you’ll have a private consultations where you can actually talk to the pharmacists in confidence.

GILES: Dr Baig, what role can pharma play?

DR BAIG Well I think we already play a bit of a role by making sure that the leaflet that you get in every prescription pack of medicines gives a full picture of information to the patient about how to take the medicine , the importance of how to take the medicine and also a lot of information about the side effects you can get from taking the medicine but practically in the digital age we can make sure that information is available in places that people look for it, I’m thinking the internet and websites as well to support people in understanding how to take their medicines.

GILES: And what would you say are the major concerns regarding the overuse of medications?

MR PATEL Well one of the main concerns is about superbugs, we heard it on the new last week’s where patients are not taking the antibiotics or not completing the course and then you get superbugs. And also the other risk of not taking your medicine is that the doctor may think well hold on second I’ve prescribed your something and it’s not working so they will give you something stronger and before you know it you’ve been treated for something you may not need to be treated for.

DR BAIG Yes absolutely, I think as well we need to think about the fact that actually wasted medicines or not treating medicines can cost the NHS quite a lot of money, almost 300 million pounds is wasted in medicines not being taken appropriately and obviously it might lead to more people attending A and E with problems that are related from not taking the medication and that can put a burden on the NHS as well.

MR PATEL And also if your taking more then what’s recommended on the dosage you can get more side effects and also other complications so always try to stick with what’s on the label, what’s on the patient leaflet and stick within the recommended guidelines because the drug companies have tried and tested these products over five to ten years and when they come to the market place you need to stick to what’s on the tin.

Pharmacy Voice was formed by the three largest community pharmacy owner associations to create a stronger, unified voice for their independent and multiple members. The founding members of Pharmacy Voice are the Association of Independent Multiple Pharmacies (AIMp), the Company Chemists’ Association (CCA) and the National Pharmacy Association (NPA).