Last year, as a previously completely fit and healthy GP of 32, I developed a sore throat, cough, and fever. Nothing so unusual about that and being fully aware of the NICE guidelines on prescribing in respiratory tract infections it did not cross my mind to see a doctor or self-medicate with antibiotics.2 My Centor score of two would have suggested I would be unlikely to benefit. For me, as I suspect for many GPs of my generation, being a relatively low prescriber of antibiotics was a badge of honour and I knew the chance of serious complications was low.
Within 48 hours I had become increasingly unwell with a high fever despite regular antipyretics. I was vomiting and so weak I could not get out of bed. My sensible (non-medical) husband took me to the out-of-hours GP and I was admitted. I had a temperature of 41.7°C, pulse of 120, and blood pressure of 80/60. My C-reactive protein was 450 mg/l and I was acidotic. I was diagnosed with pneumonia and treated with intravenous antibiotics. I was separated from my breast-fed baby who was not allowed to see me for 4 days. Blood cultures grew a Group A streptococcus and when, a week later, I still had a temperature of 39°C on paracetamol, a CT scan showed an empyema. A chest drain provided some relief but when my temperature remained high and a repeat CT scan showed that the empyema had not resolved I was transferred to a tertiary hospital for a thoracotomy. Complications meant a blood transfusion and an unplanned post-operative ITU admission. My husband was called to the intensive care unit urgently and drove to the hospital thinking he was going to be a widower. I spent a month in hospital and had 3 months off work. I was left with a hoarse voice that required months of speech therapy. It took time for me to rebuild my relationship with my son, when I first came out of hospital he would cry if he was left alone with me.
Would an early course of penicillin have halted the Group A streptococcus in its tracks? I have no way of knowing. I do, however, strongly agree with Stanton et al that research into identifying patients likely to benefit from antibiotics is an urgent priority. Although rare, complication of respiratory tract infections can be devastating.
- © British Journal of General Practice, 2011
