Antibiotics Prescription

I’m just looking for a little advice and I don’t know where else to turn. Does anyone know if a patient has the right to question a prescription if the risks seem to outweigh the benefits?
My dad is 85 and has suffered with mobility problems for the last 20 years without a definitive diagnosis. He has ulcers on both heels and on one toe on each foot. He was recently in hospital with an infection in one foot but responded well to antibiotics. He was discharged with Clindamycin antibiotics and these wounds have really improved. I change the 4 silver dressings every 24 hours as we had issues with community nurses not turning up. The antibiotics are finished but there is an infection in the other foot now.
The doctor has prescribed Ciprofloxacin which is a much stronger antibiotic with known risks and side effects especially in the elderly. My dad was only discharged from hospital when I could prove that I could assist him to transfer from bed to wheelchair. I queried the choice of antibiotics because he has background heart failure, kidney problems, a history of high blood pressure which are all stated on the Ciprofloxacin leaflet, NHS website and in the NICE guidelines as being reasons for not taking this medicine. However the main issues for him are that he has a stoma bag and the side effect of diarrhoea is difficult to manage. Also there is a possibility of tendon damage which means the little mobility he does have would be gone and I wouldn’t have the strength to be able to lift him from bed to chair. As he already has an erratic heartbeat, shortness of breath, pain and swelling in his joints which are some of the side effects, I asked the doctor how we would know if he was having a bad reaction? In reply I was told that being unconscious would be a sign. Obviously I would like to know before dad got to that point.
When I told the GP that we were worried that the risks outweigh the benefits I felt that my concerns were not being listened to and it was a case of do as your ‘betters’ tell you. I don’t understand why the treatment that worked so well on the other foot can’t be repeated? He was not even given this strong antibiotic when he was admitted to hospital.
My question is, does my dad have the right to ask for a less risky treatment where his quality of life is considered too? If he was very ill with the infection I would understand the need for such a strong prescription but he is not. I told the doctor that dad had chosen not to take Ciprofloxacin after reading the advice but the doctor said she would only continue to monitor his condition rather than prescribe something else. It feels like treatment is being withdrawn because he is questioning her choice of prescription. There are other less risky antibiotics for someone with his comorbidities but the doctor doesn’t seem to want to consider these.
Has anyone had a similar experience or could offer any advice please?

Yes, anyone as a right to discuss their medication and ask for alternatives.

Options ask to speak to anther G.P. in the practice and/or the practice manager. Speak to a pharmacy keep to the drug description and side effect medical history etc.

Is the dosage high maybe speaking to a pharmacy or G.P. It can be taken at a low dose to start and if no effects up it to the recommended amount.

Many thanks for advice. I had to ring the surgery to find out about test results and the first Dr I spoke to did say speak to a pharmacist as he wasn’t a specialist. O spoke to my local pharmacist who agreed with my need to query and suggested NHS 111. The pharmacist from 111 was lovely and went through all of my concerns. We were on the phone for over half an hour. That’s why I was surprised when the GP wouldn’t really listen. I said I had spoken to a pharmacist but it seemed a case of I’m a dr and that tops a pharmacist. If dad was presenting with bad symptoms of infection I would understand the need for strong antibiotics. As the weaker ones seemed to be working with less risk I can’t understand why they won’t continue with them.

My mum had all sorts of sores towards the end of her life, and increainly strong antibiotics, which worked for a while, then didn’t any more.
One made her feel terrible, so terrible she refused to take it any more.

Doctors usually start with the most basic and then more aggressive if the simple ones don’t work, but you have to accept that your dad may end up in the situation of nothing working in the end. His body may simply be too weak to fight the infections.

I’m dismayed that you are expected to lift dad from chair to bed, that’s not considering your own well being.
There may soon be no option but residential care.

Thanks for the feedback. Dad can only shuffle very slowly now. He was driving up until 3 years ago. He went into hospital and came out with little mobility and bed sores.
I just help him up and am there to support him as he takes a few steps. If he gets irreversible tendon damage from the antibiotics he won’t be able to transfer without a lot more help. That’s why he doesn’t want to risk the tablets. The foot that he was admitted to hospital for has responded well to the weaker antibiotics and this new infection in the other foot has appeared since the tablets stopped. He would just like a chance to try something less radical first. My concern is that it seems to be do it the doctors way or nothing.
Thanks for listening. Sharing a problem does help.

It is so difficult watching our once fit parents decline.

I totally agree. Dad feels really well and is leading nearly a normal life apart from me helping him to get up and go to bed. If he couldn’t mobilise a little, I wouldn’t be able to help him. He would be too heavy if I did have to lift him. The OT has shown me how to assist him without hurting myself. He doesn’t want to take something that would make him unwell. I will back him in not taking the strong tabs and hopefully the doctor will have a change of heart and try something else. We just wanted to know if it was reasonabl to allow someone to have input in their choice of treatment or do you have to blindly follow what the doctor says? The NHS website and NICE guidelines say prescribe with caution in the elderly. When I mentioned this the doctor said they are only guidelines. Why bother having them then if they can be ignored? Thanks again for listening.

I’ve come rather late to this but I think there’s just one thing to point out. Depending on when the old antibiotics finished before the new infection in the other foot…the original antibiotics would have cleared that infection before it developed if they were going to do the job. If you’ve been on a particular antibiotic and that has not done the job, the automatic first response is to go stronger.

This happened with my wife quite recently. The antibiotics were so strong she had to have steroids with them to ease the side effects that went with them. We monitored her every day to make sure she wasn’t hitting problems or having the steroids mask them.

It’s pretty scary. And yes, we were more than happy to ask questions. Some doctors are still not used to that…

Thanks Charles. That’s really helpful. I will try to talk to the doctor about how to mitigate side effects. She might be more helpful if she feels we are trying to comply. We are only questioning the strength of antibiotic because dad was only discharged from hospital because the antibiotics were working and the foot that he was being treated for is actually healing after a year and a half of just getting worse. The problem is now with the other foot which the hospital said they weren’t concerned with. He has only had Flucloxacillin and Clindamycin so far so I’m just querying why go straight to the hard stuff when it would be risky? As you say though after a while you build up a resistance to a certain antibiotic and continued use has no effect.
Thanks again. I hope your wife is on the mend or at least feels well enough to have some quality of life. I hope you are okay too. I generally cope with things well but things like this make me worried and tired which makes my caring duties so much harder.

Hi Carol

We all hit stages like that. I’ve had a few myself over the years: you’d think I’d be immune now, but it doesn’t work that way.

Happy to be of help.

My wife is doing ok at present: the last lot of antibiotics was in August (fifth lot in 5 weeks) but it seems to have done the trick and no major side effects. Better still, no recurrence so far!

Thanks again Charles. Glad to hear things are looking positive. May I ask which antibiotics your wife was prescribed? Don’t worry if you would rather not say. My dad had Flucloxacillin tablets first which did nothing but then had IV Flucloxacillin in hospital and oral Clindamycin on discharge. These seem to have worked well on the original foot but now the other foot has started to get worse so Ciprofloxacin has been prescribed.
I have put all my concerns in a letter to the GP so we will see what happens next. My dad has now been without any antibiotics for 2 weeks.
Sorry for the late hour when posting. I’ve just finished changing dad’s 4 different dressings, emptying catheter, changing colostomy bag and administering medication. I don’t know how I find the time to post on here as well! Haha!

Carol, dad was entitled to 6 weeks free Reablement care. Was it arranged for you both?

The antibiotics my wife was on were for a very severe sinus infection. She’d had something like 3 lots of different ones before that one. Can’t remember the name - it was a mouthful!

Yes dad had his 6 weeks of reablement. I’ve had my Carer’s Assessment and all agencies are happy with what I do. I am not concerned about the things I have to do for dad and am more than happy to do them. I volunteered to change the dressings as from past experience the community nurses are over stretched and this must be a worse situation now with more Covid worries. We also bought a wheelchair accessible vehicle to be able to get out and about and get to appointments. Dad is in a wheelchair but apart from the foot ulcers is not unwell and is keen to live as much of a normal life as possible. The only time he has seemed unwell and depressed is when he was under the care of the community nurses for 6 months when he was discharged from his first hospital stay in Oct 2020. Waiting around all day for nurses who often didn’t turn up (not their fault as they are overstretched) was soul destroying for an active person like him and resulted in a painful sore on his bottom.
Thanks for your concern Bowling Bun but dad and I are fine with our situation and try not to be a burden on the NHS. I just can’t understand why this strong drug has been prescribed when the Patient Leaflet, NHS website and NICE Guidelines say prescribe with caution for someone with his co morbidity.

P.S. Bowling Bun
You are worse than me as I see you were posting at 4 in the morning! Thanks for responding. Just having a sounding board really helps.

Unfortunately no resolution with this issue yet and now another Dr has prescribed iron tablets which dad can’t take because he has a stoma. The advice leaflet with this prescription also says do not use with the antibiotic that caused the issue last week.

I now feel that I can’t query this inappropriate prescription because the surgery will think I am just looking for a chance to challenge them again.

Does anyone know if doctors check a patient’s medical history and co morbidities before prescribing? I’ve always assumed that they did but if it is not standard practice then that would explain why dad’s last prescriptions were inappropriate and possibly dangerous.
Does anyone have any ideas about how I can approach the surgery with my concerns again without looking like I’m being critical? In the meantime I’m also worried that the medical conditions these were prescribed for are going to get worse without some form of treatment.
I don’t want to formally complain to anyone as the surgery is generally very good and I wouldn’t wantvto cause any bad feelings.

HI Carol,

regarding the iron tablets and your Dad having a stoma, I would query it with the pharmacist, they tend to be more knowledge than GPs about medication or does your Dad have someone that monitors his stoma? This health professional can then raise concerns with the GP surgery rather than it being you. The GP should certainly be checking your Dad’s health records before prescribing. It’s a good job you are vigilant.


Melly’s right - definitely check with the Pharmacist. If they’re not happy they’ll raise it with the GP. GPs are supposed to check these things but tend not to. Some GPs now have a practice Pharmacist to monitor stuff like this.

Thank you to everyone. I did consult the pharmacist next door to the surgery first and then spoke to dad’s stoma nurse. I will have another chat with him and see if he does have links with the surgery. That would be a good way of raising a concern without stepping on anyone’s toes! It’s getting a bit tiring having to be so vigilant and I think sometimes dad thinks I’m fussing!