Tetracycline was used by our practice as a first line antibiotic for 8 years before last year. We were then visited by the medical advisers from the local health authority, who advised us that we were acting irrationally, contravening the General Medical Council's guidelines on good medical practice and wasting NHS funds. We were also advised that failure to change our prescribing would result in our not being reaccredited. Your readers may find this surprising as, of course, reaccreditation has not yet been introduced.
The health authority includes oxytetracycline as its antibiotic of choice, and it was strongly recommended that we switched to the use of this agent. The report from the local microbiology department knows of no difference whatsoever between tetracycline and oxytetracycline and, when using test strips on cultures, will use the terms interchangeably. In other words, the culture may have been found to be sensitive to oxytetracycline, but the lab report may state sensitivity to tetracycline.
A visit to the local hospital pharmacy also found that the staff use the drugs interchangeably, and, although the script may state oxytetracycline, the patient may well be given tetracycline and vice versa. A discussion with several local community pharmacists implied that this is not uncommon practice.
In 20 years of practice I have never been recommended by our local hospitals to prescribe tetracycline, although I am often recommended to prescribe other more expensive options and have received many complaints from my colleagues for the use of tetracycline. I believe that my compliance with recommendations is limited fundamentally by the bewildering array of diametrically opposed recommendations I am constantly receiving and the fact that there seems to be little practical logic to many of them. In conclusion, I would cite as my only reference a very old book that states that a man cannot serve two masters.