Now we need a globally agreed system of anti-biotic triage - you can have anti-biotics, but only administered in hospital, signed off by two doctors and with these life threatening conditions.
It's possible to find middle ground, and I think comprehensive IT systems for all doctors with real-time forbidden drugs lists and epidemia tracking would make this much easier.
It's even possible to divide hospitals into "different drug is forbidden here", and when someone has MRSA - put him in a hospital where the drugs that doesn't work on him - are banned anyway. And use "last ditch" drugs only in these hospitals.
And of course the main thing is to stop abusing antibiotics for agriculture.
I am advocating a more restrictive and considered prescription regieme - specifically only allowing hospitals to prescribe is an example not a policy decision
That's said I am under convinced it would overwhelm hospitals. Hospitals seem overwhelmed to me because A&E is a faster and more efficient way "into" the system than community based care or other approaches.
The common case is elderly care - almost no funding for in home nursing help, hard to get through the process, and elderly struggle on until a manageable chronic complaint turns acute, leading to ambulance, A&E admittance and a struggle for scare beds in wards. Whereas the hospital probably could have been avoided through treatment at home / locally.
Until we pay for community systems we won't relive the pressure on hospitals. And this out centre of excellence will just be fire fighting.
(Excuse the sudden rant - not sure where that came from :-)
Antibiotic use in humans has rarely been a problem, it's the way that "restricted" antibiotics are used on lifestock freely and in large quantities that keeps screwing us over.
Sometimes you have national organisations that provide advice about antibiotics, and you have doctors wanting to follow that advice, and you have patients who want to follow that advice, but a stupid rule by eg childcare means that everyone caves and prescribes antibiotics when they're not needed.
> Acute infective conjunctivitis is common among preschool children. Public Health England (PHE) recommends that children with conjunctivitis do not need to be excluded from child care, but childcare providers are required to determine their own sickness policies and prior research suggests that children are often excluded until they are treated or have recovered. How the content of these policies impacts on prescribing decisions has not been quantified.
[...]
> Acute infective conjunctivitis (AIC) is a common condition in preschool children.1 It is usually mild and self-limiting, often with no requirement for treatment or a doctor’s appointment.2 Evidence suggests, however, that parents and guardians are advised by childcare providers (CPs) to take their children with conjunctivitis to their GP for assessment.3–5 Furthermore, some CPs will not permit affected children to return to child care until antibiotics have been prescribed,3,4,6,7 thus parents are obtaining antibiotics to get their child readmitted. A situation in which antibiotics are prescribed for non-clinical reasons is difficult to justify and requires further investigation.
> Although most cases (50–75%) of AIC are bacterial in origin,8 the aetiology is difficult to determine clinically and only 36% of doctors are confident in differentiating between viral and bacterial conjunctivitis.9,10 In bacterial conjunctivitis, there may be some clinical benefit obtained from topical antibiotics;11 however, this benefit is perhaps not seen in children and topical chloramphenicol shortens the duration of symptoms by only 0.3 days.2 Despite this, most clinicians usually prescribe antibiotics for AIC.10
Treat them with care this time round