Antibiotics or not?

[Jackoh]

Hi

Just a query really. Went on family holiday and one of the son in laws had a very bad throat, which went onto his chest but couldn't avoid him completely as we were all on holiday together. Since returning home, husband has been quite poorly with very sore throat, bad chest, bad cold. I' ve been trying to avoid him too! I'm on 19 mg of Pred (has just taken me 6 weeks to reduce down from 20 mg after being stuck on 20/19 mg now for a year) and Lefludomide.

I rang the doctors and explained situation as coming up for weekend and I was developing a very sore throat and tightness in my chest and I asked for a prescription for antibiotics to only use only in an emergency if I felt my symptoms were getting worse. I just got a message via the receptionist that this request was refused. I was told that if I had an infection then I was to go to the surgery( you can never get an appointment!) and then antibiotics may or may not be given. Last time I went with an chest infection they were refused.

At the moment I have a very tight chest and a productive cough with yellowish phelym and a sore throat. I understand the dilemma of doctors over prescribing antibiotics but also I am a bit concerned about the fact that I am on Pred and the Lefludomide and I certainly don't want to risk a flare and have to raise the Pred. What I find when I go to the GP is that the chest infection is looked at in isolation and if not serious enough I'm told to go home and do all the things I'm doing anyway- resting, honey and lemon drinks, plenty of fluids, paracetamol, gargling with salt water for throat. They don't seem to get the fact that the steroids can sometimes mask what's going on and the problem of the infection for me is not the infection per se but the effect it has on the inflammation level and consequent effect on GCA/PMR symptoms. Unsure really whether to just carry on or go to see the GP tomorrow if symptoms don't improve but have a suspicion I will just get fobbed off again. I know that often they say that the infection is just viral and will clear up of its own accord but I also know on these two drugs it's better to catch these things early. What do folks think?

Thanks Jackie

[DorsetLady PMRGCAuk volunteer]

Hi Jackie,

Think the only thing you can do is see GP tomorrow, explain your concerns as strongly as you can and take it from there.

Your inflammation levels will most certainly be increased, but it will be inflammation caused by the infection not PMR, so there should be no reason to increase your Pred.

[Bittebitt in reply to DorsetLady]

Visit your gp tomorrow and remind them that they must take into consideration that you are immunosuppressed both on pred and leflunomide, and therefore cannot be treated as one of their usual patients. Both medicines can mask an infection to a degree that it may become very serious before it becomes evident.

[Jackoh in reply to Bittebitt]

Thank you Bittebitt. Will see how I feel tomorrow and yes I agree need to reinforce the fact that I'm on these two drugs ( which I mentioned to them before via the receptionist) but maybe I need to go and speak to them in person.

[Jackoh in reply to DorsetLady]

Thank you Dorsetlady for your reply. Yes will have to go and be as pleasant but assertive as I can as I don't feel they particularly understand these conditions. I wasn't too worried about inflammation levels going up ( my bloods never show this anyway ) but the effect this has on symptoms of head(GCA). Had a bit of earache and PMR( pain and stiffness become a bit more evident) and didn't want to flare because of condition if that makes sense. Don't want to be a hypochondriac! But want to avoid a flare at this stage if I can ! Xx

[DorsetLady PMRGCAuk volunteer in reply to Jackoh]

Absolutely - totally agree.

[PMRpro Ambassador]

If you can't get an appointment as an emergency then there is something wrong. Don't take the receptionist's say-so, ask to speak to the manager if necessary. Don't be fobbed off. And if you feel really unwell - there is always 111 and OOH (Out Of Hours)

[Jackoh]

Yes have had to resort to walk in centre at hospital before. Have felt annoyed really that even when leaving message for regular GP they don't seem to join up the dots!! I have to get over it !! doesn't really get you anywhere starting off feeling annoyed- best to work up to it !!! 😜

[Jackoh]

Should have explained more clearly really that message received from receptionist re antibiotics wasn't her opinion but reply message from my GP .

[PMRpro Ambassador in reply to Jackoh]

Yes - I got that but it is the receptionist you will have to face to get in to see a GP as an emergency.

And who knows how the receptionist fed your request to the GP? Sometimes it is like a game of Chinese whispers...

[Jackoh]

Yes true

[Jackoh]

Saw a really nice GP at the practice this morning who I've never seen before. He agreed with symptoms and seemed to understand what I was saying so has given me a short dose of antibiotics.