Expert warns of the dangers of using old antibiotics

A health expert has issued a warning to people not to save unused antibiotics at home to take later at their own discretion – as this risks more harm than good.

As concerns over antibiotic resistant infections grow, an expert from Healthcare Improvement Scotland has urged people to avoid using antibiotics they may have saved up at home, as their overuse presents a serious threat to the future of healthcare.

Professor Andrew Seaton, Chair of the Scottish Antimicrobial Prescribing Group (SAPG), part of Healthcare Improvement Scotland, said: “We know that many people have antibiotics at home which they or another family member have been previously prescribed and there can be a temptation, when feeling unwell, to use them.

“However, it’s quite likely, at times when chest and throat infections are common, that infection will be caused by one of the many circulating viruses rather than by an infection that requires an antibiotic.

“Antibiotics will not speed up recovery from a viral illness and they may cause unwanted effects including stomach upset. Critically, future infections may be more difficult to treat because overuse of antibiotics drives the development of antibiotic resistance.”

Using antibiotics that have been lying around the house for a while means they may also have expired. Once the expiration date of a medicine has passed there’s no guarantee that it will be either safe or effective.

 A survey of 2000 people in 2022 found that one in three people said they had taken expired medicines and almost a third of these said they had taken medicines that were not meant for them.

The most common reason for an antibiotic prescription is for respiratory tract infections eg infections of the throat, ear or chest.

Professor Seaton, an infectious diseases consultant in NHS Greater Glasgow and Clyde, explained: “Although we are making progress in getting across the importance of not overusing antibiotics, we know that the pandemic has had a significant impact on our healthcare system including the way in which people access healthcare advice.

“We think this has at least contributed to an increase in the use of antibiotics. Work is still needed to protect our population from the very real threat of antibiotic resistant infections and to help preserve our precious antibiotics for future generations as well as for those who need them most now.”

Professor Seaton has also highlighted the importance of safe disposal of unused medicines. He said: “Antibiotics don’t only act on germs inside of us, but also act on the many germs living in soil and water and we know that antibiotic resistance in the environment has important consequences for plant, animal and human health.

“It’s essential therefore that we avoid environmental contamination by not disposing of antibiotics in household waste for landfill or flush them down the toilet. Safe disposal of unused antibiotics will reduce the environmental impact and help protect our planet.”

Global analysis of more than 200 countries in 2019, before the COVID-19 pandemic, estimated that infections due to antibiotic resistance are now a leading cause of death worldwide, higher even than HIV/AIDS or malaria.

More than one million deaths are estimated to occur annually as a direct result of antibiotic resistant infections due to common, previously treatable infections such as pneumonia and bloodstream infections.

In a bid to encourage people to safely dispose of unused antibiotics, pharmacies throughout Scotland are offering an ‘amnesty’ where people can return medicines to them to be safely disposed of.

Professor Seaton said: “For the majority of people who are feeling unwell with a cough, cold or sore throat, symptoms will settle with simple measures including rest, increasing fluid intake and careful use of pain killers like paracetamol.

There is a useful check list which people can go through on the NHS 24 website to decide if further advice is needed Cough | NHS 24 .

Professor Seaton added: “For people with known serious underlying health conditions or for those where symptoms are not settling within a few days or are worsening it is advisable to take advice from NHS 24, their pharmacist or GP.”

Inspection report for Royal Infirmary of Edinburgh, NHS Lothian

Healthcare Improvement Scotland has published a report relating to an unannounced follow-up inspection visit to the Royal Infirmary of Edinburgh, NHS Lothian. The inspection took place in September 2023.

The purpose of the follow-up inspection was to assess progress and provide assurance on NHS Lothian’s improvement actions in response to serious patient safety concerns that were identified and escalated during a previous inspection of the hospital in February 2023.

To provide assurance of improvement following the concerns previously identified, the main focus of the follow-up inspection was the emergency department. Inspectors also visited a number of wards and the medical assessment unit.

Donna Maclean, Chief Inspector, Healthcare Improvement Scotland, said: ““Serious concerns raised in our previous inspection related specifically to the safe delivery of care and to potential patient safety risks. During this follow-up inspection we observed that considerable progress has been made in responding to these concerns.

“The delivery of fundamental care has improved with the addition of care and mealtime coordinators in the emergency department. Improvements have also been achieved in supporting patient care, dignity and leadership and in the coordination of care within the department.

“Implementation of a new continuous flow model has improved the flow of patients through the hospital during weekdays. However, further work is needed to support the timely flow of patients from the emergency department to an appropriate care area out of hours and at weekends.”

Six of the previous 13 requirements have now been met and progress has been made with four requirements, with further work to be undertaken.

Three requirements have not been met. These include hand hygiene, the use of personal protective equipment and the management of intravenous fluids.

One new additional requirement has been added with regard to the safe management of cleaning products. One new recommendation has been added in relation to the timeframes for the completion of significant adverse event reviews.

An improvement action plan has been developed by NHS Lothian in order to meet the requirements.

The full inspection report is available to view at: 

Royal Infirmary of Edinburgh (healthcareimprovementscotland.org)

Scots want to see more done to limit tobacco sales and use

A report published yesterday by Healthcare Improvement Scotland finds that people want more to be done to limit the sales of tobacco products.

The survey, commissioned by the Scottish Government, asked questions which will form part of a refreshed plan to be published this autumn, to support a tobacco-free Scotland.

The Citizens’ Panel survey, which ran between November 2022 and February 2023, found that of the 667 people who responded to the survey, 75% want more action to be taken to further limit who can sell tobacco products, and while 63% agreed the legal age to buy them should be raised from 18 to 21, 25% were opposed.  

Some 65% agreed that Scotland should increase the legal age of the sale of nicotine vaping products from 18 to 21 years.

In addition, the survey found that 80% of respondents said that they either strongly agreed or agreed that action should be taken to further limit who can sell nicotine vaping products. Just 9% either disagreed or strongly disagreed.

In addition, 67% felt packaging, in pack information and the appearance of cigarettes should be made more unappealing. Some 64% agreed that taxes on tobacco and vaping products should be raised, but nearly a quarter of respondents (23%) disagreed with this.

There was also wide agreement that the smoking ban should be widened to create more smoke-free areas where children congregate, such as outside schools and play parks, with almost nine in ten respondents (86%) in agreement. Just 8% disagreed.

The report recommends that the Scottish Government considers including all the measures that have the strongest public support in its Tobacco Action Plan 2023.

It adds that the Scottish Government should then consider further around more punitive measures, such as raising the age of purchase and raising taxation on tobacco and vaping products. After assessing the impact of these measures, these could also be implemented following a staged approach.

Clare Morrison, Director of Community Engagement at Healthcare Improvement Scotland said: “As Scotland looks to become tobacco-free in the near future, this shows that the majority of people believe more should be done to limit access for younger people to tobacco and vaping.”

Visit our Community Engagement website to access the full report.

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