GP dilemma: A patient requesting antibiotics to take on holiday

A healthy patient presents requesting antibiotics to take on holiday, 'just in case'. What are my obligations?

Dr Zaid Al-Najjar, medicolegal adviser team leader at the Medical Protection Society advises:

This is a not altogether uncommon scenario in general practice. An example of such a request might be because the patient is worried that he or she may develop diarrhoea/gastroenteritis whilst on holiday and would like antibiotics to treat this to save him or herself from going to a pharmacy or seeking medical help.
 
The GMC is very clear in Good Medical Practice:

  • In providing clinical care, you must prescribe drugs or treatment including repeat prescriptions, only when you have adequate knowledge of the patient’s health, and are satisfied that the drugs or treatment serve the patient’s needs
  • Provide effective treatments based on the best available evidence
  • Check that the care or treatment you provide for each patient is compatible with any other treatments that the patient is receiving, including (where possible) self-prescribed over-the-counter medications.

In its prescribing guidance, the GMC states:

You are responsible for the prescriptions you sign, your decisions and actions when you supply and administer medicines and devices or instruct others to do so. You must be prepared to explain and justify your decisions and actions when prescribing, administering and managing medicines.
 
Should patients become acutely unwell abroad, in most circumstances, they will have access to medical advice and care and it might be helpful to check whether they have appropriate travel insurance.

Prescribing antibiotics in anticipation of an acute illness is fraught with difficulty as a doctor is essentially prescribing in the dark. For most acute illnesses there are many potential underlying causes, and consuming antibiotics is only one of the potential treatments. They can in some cases make things worse and delay a patient seeking help.

The GMC states that a doctor should explain the likely duration of treatment and arrangements for follow up. This would be difficult to do, if you do not know what you are treating.

Explore patient concerns

The GMC also advises that doctors are not obliged to provide treatment if they do not consider it to be of overall benefit of the patient even if asked by the patient to do so. Doctors should explain their reasoning to the patient, and explore other options, including the right to a second opinion.

It would therefore be helpful to explore the patients’ concerns, and explain why the prescribing of ‘just-in-case’ antibiotics might not be in their best interests. Treating an acute illness with antibiotics could potentially make things worse and stop the patient seeking help which might undercover the real cause of the illness.

It could also be difficult to anticipate what other medications or treatments that the patient might take whilst abroad, and what interactions these may have with a ‘just-in-case’ antibiotic, for example, over the counter anti-malarials or pain relief.

There will of course be cases where it may be appropriate to prescribe medications in advance of a trip abroad but these are few and far between, and each case needs to be considered carefully on an individual basis. A doctor needs to remember that he or she should be prepared to justify the reasoning behind that decision.

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