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Q1: My doctor is reluctant to prescribe antibiotics whereas my neighbour's practice hands them out like Smarties. It seems to me that my neighbour always gets rid of her infection rather quicker than I do. Is my doctor right? Name and address withheld.

A1: It is impossible to comment on this question unless one knew all the facts but there is evidence that too many antibiotics are being prescribed for trivial complaints that would have cleared up rapidly without complications. The discovery of antibiotics is arguably the greatest medical advance of the twentieth century. The problem is that bacteria rapidly acquire resistance to each new antibiotic so that eventually a state is reached when some bacterial organisms are resistant to all the commonly used and relatively safe antibiotics.

The difficulty the doctors face is that whenever they write out a prescription for a patient they are aware that there is some conflict of interest between achieving immediate, but often small benefit to the patient, while at the same time possibly undermining the care of the community. Every prescription of an antibiotic increases the chance that more resistant strains of bacteria to the prescribed antibiotic will be let loose on the general population. Once there are resistant strains in the community it is only a matter of time before these will be introduced into the local hospital to add to the local burden posed by MRSA and Clostridium difficile.

Antibiotics need to be prescribed with care and once prescribed taken assiduously, as instructed, by the patient. The possibility of encouraging the growth of a resistant strain is increased if someone doesn't complete the full course as determined by the doctor. Even worse is the situation when an ill patient finishes off some earlier bottle of antibiotic pills left over from a previous infection without knowing whether these will be the correct antibiotic, whether they are still active and whether there is enough of them.

There is some evidence that although antibiotics have no effect on a viral infection they may appear to shorten viral illnesses by preventing a secondary bacterial infection. If the viral infection is relatively trivial, if the patient has a normal immune system and no history of, for example, recurrent severe bronchitis there is no justification for prescribing an antibiotic for the normal run of viral infections in previously fit patients. It can't be said too often that antibiotics are effective against bacteria but not viruses. Nor should antibiotics be prescribed for a minor bacterial infection that the patient's immune system will rapidly deal with.

The same problem of producing resistant strains is met if the anti viral agents are over prescribed for viral infections.

Q2: My 14 month old daughter suffers repeated chest infections that mean she is being prescribed antibiotics every two months. Is this too often for a young baby and is there any alternative? Joy Birch, Colchester.

A2: I have no doubt that your doctor will have carefully considered this before giving your daughter the antibiotics. It is always difficult to know whether a child is coughing and wheezing because of an infection, or if it suffers from some other form of wheezing such as asthma. This may need different treatment.

Furthermore it is hard to tell whether there is a bacterial component to any infection or if it is entirely viral. If the persistent recurrent infections associated with a wheeze persist it might be as well to discuss your worries with your doctor and ask him or her whether it would be a good idea for your baby to see a paediatrician with an interest in respiratory diseases.

Recurrent chestiness, for want of a better word, is a problem in many children. My eldest grandchild suffered from this and was repeatedly going into the local hospital. Tests at Great Ormond Street revealed that he had a form of congenital immune deficiency and that he was likely to outgrow this by the time he was 18 months to two years. This proved to be the case but in the meanwhile he was kept as right as rain by having continuous antibiotics. I mention this to show how hard it is to make hard and fast rules without knowledge of all the facts.