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Antibiotics and SNAPs

March 9, 2013

Infection is the commonest acute problem that I see in primary care. Every day, patients ask me to prescribe antibiotics. My decision to comply or deny such requests will hinge on intricate calculations, involving both known and unknown variables.

Basically, I have to weigh up whether an antibiotic is more likely to help … or harm you.

Antibiotics can cause several side effects, such as diarrhea, vomiting, yeast infection and rashes. Irresponsible usage increases germ resistance and breeds superbugs. Correct usage will cure and prevent complications.

When you develop an infection, there are 3 possible scenarios:

1)      You don’t need an antibiotic

2)      You need an antibiotic

3)      You might need an antibiotic

The third scenario is the tricky one. This is where I often write out a safety net antibiotic prescription (SNAP).

A SNAP is a deferred or delayed prescription, i.e., you fill it only if you need to. It means that you do not need an antibiotic immediately.

So, under what circumstances do you fill this prescription?

You should fill the prescription if your symptoms don’t improve within 48 to 72 hours or if your symptoms get worse. If you decide to fill it then you need to come back to see me because I have to re-examine you and assess for interval change.

This strategy is part of my ‘shared-decision making’ approach. As my patient, you are my partner and we make decisions together. I am an expert on disease and you are an expert on your own body.

Here are some of the common conditions that I use SNAPS for:

  • Ear infection (usually lasts for 4 days)
  • Sore throat or tonsillitis (usually lasts for a week)
  • Cold (usually lasts one and a half weeks)
  • Sinus infection (usually lasts two and a half weeks)
  • Cough or bronchitis (usually lasts three weeks)

The above problems are usually caused by viruses. Sometimes, I tell patients that they will get better in a week if they take an antibiotic and seven days if they don’t.

As a final word, remember that I have simplified a very complicated matter. I believe that patients must see a doctor in order to help them decide whether an antibiotic is appropriate or not. The decision is not easy and requires medical training and expert guidance.


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