Will taking antibiotics for life help poor immunity? Ask GP DR MARTIN SCURR

Question: TEN years ago, my grandson, 20, had to have his spleen removed after falling from a roof. He was told to take penicillin daily for the rest of his life and he did so without exception. Recently I was told that this was not necessary and that this medicine did not help his condition.

James Marr, Alveston, Glos.

A: The spleen plays a crucial role in the immune system: it produces white blood cells that fight infections and filters the blood. So if you don’t have a spleen, you run a lifelong risk of contracting dangerous infections.

This applies whether the spleen has been removed after an accident, such as your grandson’s, or whether there is a problem with spleen function due to a disease such as sickle cell anemia.

There are two options for these patients: first, a daily antibiotic, such as penicillin; and second, the patient can be given an emergency supply of antibiotics that can be started immediately if there are signs of infection, such as fever. In the latter case, the patient should also seek immediate medical attention. Taking an antibiotic daily for a long period of time has several risks and disadvantages.

These include developing allergies such as to penicillin, which can be serious, and possible changes in the natural balance of the gut microbiome (the collection of microbes that we now know plays a crucial role in immunity and digestion).

There is also the risk of contracting resistant bacteria – and the fact that people may forget to take the antibiotics regularly (although this is not the case for your grandson).

If a patient has been given an emergency supply of antibiotics (usually amoxicillin-clavulanate, although there are others), it is essential that he/she remembers to have these with them at all times – at home, at work or when traveling – so that the medications can be taken and medical attention sought as soon as they become ill, no matter how mild the symptoms initially seem.

No time should be wasted, as infections in patients with no spleen or poor spleen function can develop rapidly and can even be fatal within hours.

My opinion is that the treatment your grandson is receiving is certainly worth it, but there is an alternative ’emergency’ option, and it may suit him better. He could discuss this with his doctor.

Q: Several years ago I was prescribed the painkiller diclofenac while awaiting hip replacement surgery, which would allow me to continue working. Now my other hip is causing a lot of pain. But when I suggested diclofenac, my doctor was convinced that it is no longer used and banned. Is this correct?

Jean Guilford, Oxon.

A: Diclofenac is the most commonly prescribed non-steroidal anti-inflammatory drug (NSAID) in the world and has a good reputation as a pain reliever.

But it is associated with an increased risk of heart attacks and strokes, especially among those who take it long-term or those with existing heart disease. It is also not intended for use by people with kidney conditions such as chronic renal failure (due to high blood pressure) or diabetes, because the drug can cause a potentially serious decrease in blood flow through the kidneys – possibly due to the NSAIDs causing the arteries that supply the kidneys constrict.

Diclofenac is the most prescribed non-steroidal anti-inflammatory drug (NSAID) in the world

Therefore, like all drugs in the same class, it should be administered in the lowest possible dose so that the patient can achieve pain relief.

But the use of the drug is not prohibited and I suspect that communication with your doctor has been disrupted at this point.

Instead, you may have risk factors that make diclofenac no longer suitable for you. Your GP can confirm whether this is the case.

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In my opinion… Good news about the NHS

When I first started my GP training, the experienced GP who supervised me continually emphasized the importance of my signature: having a recognizable and repeatable signature that pharmacists and others would confirm and recognize.

A GP’s signature is not only regularly used when writing prescriptions, but is also of particular importance when issuing and signing death certificates, which only a qualified doctor should do.

But this system is about to change with the introduction in April of a new role: medical examiner.

This person, who is also a qualified doctor, will now review all medical certificates – and records – issued by the last GP to examine the deceased.

This means that relatives have the opportunity to express their concerns about the quality of care their loved one has received, which does not involve a doctor being involved in their care.

If there is any doubt about this, the medical examiner may refer the case to the coroner.

Given the fragmented and highly variable state of primary care in Britain, this reassurance is a very welcome development – ​​something good about the NHS for a change.