Clinical focus: a look at antibiotics

Antibiotics are medications used to treat, and in some cases prevent, bacterial infections.

They can be used to treat everything from relatively mild conditions like acne to potentially life-threatening conditions like pneumonia and meningitis, and kill or inhibit the growth of bacteria by causing the bacteria cell wall to disintegrate.

Doses of antibiotics can be provided in several ways:

• oral antibiotics – tablets, pills and capsules or a liquid that you drink which can be used to treat most types of mild to moderate infections in the body
• topical antibiotics – creams, lotions, sprays or drops, which are often used to treat skin infections
• injections of antibiotics – these can be given as an injection or infusion through a drip directly into the blood or muscle, and are usually reserved for more serious infections

There are a number of antibiotics produced and dispensed but most of them can be broadly classified into six groups:

• Penicillins are widely used to treat a variety of infections, including skin infections, chest infections and urinary tract infections.
• Cephalosporins can be used to treat a wide range of infections but are also effective in treating more serious infections like septicaemia.
• Aminoglycosides tend to be used only to treat very serious illnesses such as septicaemia as they can cause serious side effects, including hearing loss and kidney damage. They break down quickly inside the digestive system so they have to be given by injection. They are also used as drops for some ear or eye infections.
• Tetracyclines can be used to treat a wide range of infections. They are commonly used to treat moderate to severe acne and a condition called rosacea, which causes flushing of the skin and spots.
• Macrolides can be particularly useful in treating lung and chest infections. They can also be a useful alternative for people with a penicillin allergy or to treat penicillin-resistant strains of bacteria.
• Fluoroquinolones are broad-spectrum antibiotics that can be used to treat a wide range of infections.

How they’re used in the ambulance service

General A&E operations only carry and administer one antibiotic – benzylpenicillin. Mixed with ‘water for injection’ and administered by IV or IM injection, it’s used in the treatment of suspected meningococcal disease (meningitis with non-blanching rash or meningococcal septicaemia). In these cases, the sooner benzylpenicillin is administered the better the outcome.

Critical care doctors and paramedics also carry and are able to give ceftriaxone injections (a cephalosporin antibiotic used for the treatment of meningococcal disease), and co-amoxiclav injections (used with open fractures, thoracostomies, thoracotomies, and serious respiratory infections).

In addition, our emergency care practitioners have extra antibiotics that they can supply and administer to patients, which can be used to treat everything from UTIs to skin and chest infections.

What’s the problem with using them?

Every year, European Antibiotic Awareness Day is held on November 18. It's a Europe-wide public health initiative that encourages responsible use of antibiotics.

Antibiotic resistance is an everyday problem across England and Europe. The spread of resistant bacteria in hospitals in particular is a major issue for patients' safety.

• Infections with antibiotic-resistant bacteria increase levels of disease and death, as well as the length of time people stay in hospitals.
• Inappropriate use of antibiotics may increasingly cause patients to become colonised or infected with resistant bacteria.
• Few new antibiotics are being developed. As resistance in bacteria grows, it will become more difficult to treat infection, and this affects patient care. 

Antibiotic resistance is one of the biggest threats facing us today. Without effective antibiotics, many routine treatments will become increasingly dangerous. Setting broken bones, basic operations and chemotherapy all rely on access to antibiotics that work. By using antibiotics less often we can slow down the development of resistance. It’s not possible to stop it completely but slowing it down stops resistance spreading and buys some time to develop new types of antibiotics. 

It is also important to remember that in most cases for a health individual antibiotics may only reduce the affective of the infection by a day. In high risk patients such as immunosuppressed or systemically unwell they will work better.

They are for use on bacterial infections not a virus.

People must complete the whole course of treatment, even if they feel better, if not this aids to increased risk of resistance as this doesn’t kill the bacteria.

Find out what you can do to help slow down antibiotic resistance by visiting the NHS Choices website.

Published 21st November 2014