Are insect bites responsible for the rise in summer flucloxacillin prescribing in United Kingdom general practices?

BACKGROUND: Insect bite inflammation may mimic cellulitis and promote unnecessary antibiotic usage, contributing to antimicrobial resistance in primary care. We wondered how general practice clinicians assess and manage insect bites, diagnose cellulitis, and prescribe antibiotics. METHOD: This is a Quality Improvement study in which 10 general practices in England and Wales investigated patients attending for the first time with insect bites between April and September 2021 to their practices. Mode of consultation, presentation, management plan, and reattendance or referral were noted. Total practice flucloxacillin prescribing was compared to that for insect bites. RESULTS: A combined list size of 161,346 yielded 355 insect bite consultations. Nearly two-thirds were female, ages 3-89 years old, with July as the peak month and a mean weekly incidence of 8 per 100,000. GPs still undertook most consultations; most were phone consultations, with photo support for over half. Over 40% presented between days 1 and 3 and common symptoms were redness, itchness, pain, and heat. Vital sign recording was not common, and only 22% of patients were already taking an antihistamine despite 45% complaining of itch. Antibiotics were prescribed to nearly three-quarters of the patients, mainly orally and mostly as flucloxacillin. Reattendance occurred for 12% and referral to hospital for 2%. Flucloxacillin for insect bites contributed a mean of 5.1% of total practice flucloxacillin prescriptions, with a peak of 10.7% in July. CONCLUSIONS: Antibiotics are likely to be overused in our insect bite practice and patients could make more use of antihistamines for itch before consulting.

It can be difficult to know if redness, heat, swelling, and pain from insect bites are due to inflammation or infection. Prescribing unnecessary antibiotics may result in germs becoming resistant to antibiotics when needed. Ten general practices in England and Wales investigated their management of insect bites in the 6 months of April to September 2021 inclusive. There were 355 bites; women presented more often than men, and ages were from 3 to 89 years old, half of them were 30­69 years old. People mainly consulted their GP by phone with photos of their bites. Key symptoms were redness, itchness, heat, and pain. More people had itch than were taking antihistamines or using steroid cream. Most people (nearly 7 out of 10) were prescribed an oral antibiotic, usually flucloxacillin, which accounted for about 5% of total flucloxacillin prescribed in the practices. Only 2 in 100 people needed further hospital care. It is likely that general practice clinicians are over-using antibiotics for insect bites and that home management before seeking medical help with painkillers, antihistamines, and steroid creams could be used more. Now that we have baseline data, there is a need to set up studies to prove that these reduce antibiotic usage.

Evidence that low-dose, long-term genistein treatment inhibits oestradiol-stimulated growth in MCF-7 cells by down-regulation of the PI3-kinase/Akt signalling pathway.

The reduced incidence of breast cancer in certain Eastern countries has been attributed to high soy diets although this evidence is simply epidemiological. One of the major constituents of soy is genistein, but paradoxically this phytoestrogen binds to oestrogen receptors and stimulates growth at concentrations that would be achieved by a high soy diet, but inhibits growth at high experimental concentrations. To determine the effects of low-dose, long-term genistein exposure we have cultured MCF-7 breast cancer cells in 10 nM genistein for 10-12 weeks and investigated whether or not this long-term genistein treatment (LTGT) altered the expression of oestrogen receptor alpha (ERalpha) and the activity of the PI3-K/Akt signalling pathway. This is known to be pivotal in the signalling of mitogens such as oestradiol (E(2)), insulin-like growth factor-1 (IGF-1) and epidermal growth factor (EGF). LTGT significantly reduced the growth promoting effects of E(2) and increased the dose-dependent growth-inhibitory effect of the PI3-K inhibitor, LY 294002, compared to untreated control MCF-7 cells. This was associated with a significant decreased protein expression of total Akt and phosphorylated Akt but not ERalpha. Rapamycin, an inhibitor of one of the down-stream targets of Akt, mammalian target of rapamycin (mTOR), also dose-dependently inhibited growth but the response to this drug was similar in LTGT and control MCF-7 cells. The protein expression of liver receptor homologue-1 (LRH1), an orphan nuclear receptor implicated in tumourigenesis was not affected by LTGT. The results show that LTGT results in a down-regulation of the PI3-K/Akt signalling pathway and may be a mechanism through which genistein could offer protection against breast cancer.