Think back to the last infection that you had. Did you attend your GP surgery and if so, were you prescribed antibiotics? Think about the literature that was displayed in the surgery regarding the use of antibiotics and consider the impact of that advice. How may the treatment of patients with immunodeficiency differ from the advice given to the general population?

In a media brief in 2014, the BMA reported an average of 6 GP visits per year per person in the UK, but if you take into account that the vast majority of those are made up by people with known health conditions, it is likely that most people with a healthy immune system will rarely attend their GP surgery for infection. NICE guidelines suggest that often patients will request antibiotics for conditions against which they are ineffective (e.g. to treat a viral infection such as a cold). Recently there has been a focus on limiting access to antibiotics unless there is evidence to suggest the presence of bacterial infection and educating patients on the danger of misuse of antibiotics. Literature is displayed prominently in every GP surgery warning against requesting antibiotics for viral infections and promoting the need to finish courses fully if you are prescribed antibiotics. This is a sensible course of action to prevent the development of microbial resistance.

The difficulty facing patients with immunodeficiency is that they can be considered exceptional – often prophylactic antibiotics will mask the clinical or laboratory signs of an infection, until it is well established. As discussed in the chapter, serious infection can develop rapidly in these patients, so they must have quick access to antibiotics that differ in class to their usual prophylactic treatment. It is also sometimes necessary to prescribe antibiotics to significantly ‘at risk’ patients who have a viral infection (to prevent secondary bacterial infection); however this is not widely understood outside of specialist practice.

In view of the increased attention about antibiotic use and possibly due to misunderstanding of the condition, patients with immunodeficiency will often report having to ‘convince the doctor’ to prescribe antibiotics. Education and intervention from the specialist team is useful to allow appropriate access to treatment for patients in such exceptional cases.

It is important to recognise that health promotion concepts can differ according to the circumstances of the individual and must take into account the needs of the general population (prevention of development of antibiotic resistant bacteria) versus the individual risk of morbidity and mortality in exceptional cases. Personalised care plans written with the input of local and specialised care providers can assist with meeting these needs.