The microbiologist had gone to review a patient on the wards when they were stopped and asked for an opinion about a different patient. This patient was being treated for infective endocarditis caused by Staphylococcus aureus and had been on IV Teicoplanin for 2 weeks because they said they were allergic to penicillin. The current problem was that the patient’s renal function was deteriorating and it was thought that the Teicoplanin might be part of the problem (although the patient was also on a few other nephrotoxic drugs but these couldn’t be stopped easily).
 
The Microbiologist knew that the best antibiotic for the infection was a penicillin, Flucloxacillin, so decided to try and get to the bottom of the penicillin allergy story. Side effects from antibiotics are common (e.g. diarrhoea and vomiting) but do not usually represent allergy. They sat down with the patient and asked them to describe what happened when they were last given a penicillin.

What a mess thought the Microbiologist. “So let me get this straight. You diagnosed community acquired pneumonia in your patient and started Amoxicillin and Clarithromycin. However on the ward round you felt it was more ‘severe’ than community acquired pneumonia so you switched the patient to the hospital acquired pneumonia antibiotics. The patient is no better, even after 4 days of these new antibiotics, so you want advice about how to escalate these antibiotics even further!?”
 
“Yes,” said the doctor.
 
“Okay, you need to put the patient back on to the antibiotics for community acquired pneumonia” replied the Microbiologist.
 
“But they’re really sick!” exclaimed the doctor.
 
“Yes and you are not actually helping them get better!!”…the Microbiologist went on to explain where it had all gone wrong…

Gosh what a controversy (Public Health England) PHE and the International Association of Athletics Federations (IAAF) have got themselves into over the outbreak of Norovirus at the London 2017 World Athletic Championships. The spokesperson from PHE, Dr Deborah Turbitt, said “PHE has been notified of a confirmed outbreak of Norovirus among people associated with the World Athletics Championships”.

​It is reported in the media that around 30 athletes and associated people, all staying at the Tower Hotel near Tower Bridge, have been taken ill over the last few days. Several nationalities are involved including Irish, German, Canadian, Puerto Rican and Botswanan. But it is the Botswanan 200m and 400m gold medal hopeful, Isaac Makwala, who has caused the most controversy, not helped by the videoed eviction at the stadium door which has been played over and over on TV and the subsequent live debate on BBC Sport.

On the ward round a patient reported to the doctor that she had developed diarrhoea on the antibiotics that had been given for her community acquired pneumonia (CAP). She had already had 5 days of antibiotics and other than the diarrhoea was feeling much better. The doctor noted the patient was afebrile and looked at the blood tests which showed the white blood cell count and C-reactive protein had reduced considerably. Knowing that the hospital antibiotic guidelines said the treatment for CAP was seven days the doctor decided to call the Microbiologist for advice.
 
The Microbiologist went through the story and the said “okay, you can stop the antibiotics”.
 
“But the guidelines say we should give seven days”, replied the doctor.

​“Yes, but the patient is better” replied the Microbiologist.
 
“So why do the guidelines say seven days then” persisted the doctor.
 
Good point thought the Microbiologist…
 
So why do we have defined durations for courses of antibiotics? Why do these appear to be carved in stone so that no doctor or patient dares to deviate from the principal of “you must finish the course of antibiotics”? Surely the correct length of course is whatever makes the patient feel better?