Medication

This page answers common questions and concerns about medications including:

• Do I need to worry about the effect of all the different drugs I take for my different medical conditions (drug interactions)?
• What do I do if I miss a dose of medication?
• Can I stop treatment when I feel better or do I need to finish the course?
• What if I have side-effects or an allergy to antibiotics?

Medication – General

If you take medicines for other health conditions, your GP and hospital respiratory team will check for any interactions. If they are concerned about an interaction, they may discuss using an alternative medicine, changing a dose or increasing the frequency of monitoring to ensure it does not cause any problems. You can also ask your community pharmacy team to check for any interactions with medicines or supplements you buy.

Generally, we do not have enough information about herbal, homeopathic or vitamin products to know if they will interact with other medicines so generally we would ask that you avoid these.

Missed doses

In order to get the most benefit from your medicines, try to take them as instructed and do not miss any doses. If you do miss a dose, do not double the next dose. If you miss multiple doses, please speak to your GP about how to restart.

The clinical team may advise you to temporarily stop long term oral antibiotics or nebulised antibiotics if you are unwell and getting treatment for an infection.

How long to stay on treatment

Your treatment will be reviewed regularly and it should not be stopped suddenly without discussing with your GP or hospital respiratory team. Some treatment will be important to continue long term to try and prevent any problems but some treatment may be stopped if you feel better.

Medication – Antibiotics

Antibiotic resistance

Resistance to antibiotics is a growing concern worldwide so clinical staff use local data and national guidelines to help make decisions about treatment. It is important not to prescribe antibiotics if they are not needed as this can increase the risk of resistance across the wider population.

If you are prescribed antibiotics, please take them as instructed and always complete the whole course, even if you start to feel better before treatment finishes.

Side effects

All medicines have potential side effects and this will be discussed with you before any treatment is started. The clinical staff will consider any other health conditions you have and any other medicines you are taking to try and minimise the risk of side effects.

Some medicines may require some investigations before starting treatment such as a sputum sample, blood tests, hearing tests or an ECG (heart trace). These tests may be repeated during treatment to ensure you are not experiencing any side effects.

If you think you are experiencing a side effect of medicines, this can be discussed with your GP or respiratory team.

Antibiotics can upset people’s gut flora and some people find probiotics can help. For more information click here.

Specific Side-effects

Some antibiotics are particularly known to cause specific side-effects. These will no occur in everyone but are important to look out for:

Doxycycline

• Increases your risk of sun burn (photosensitivity) even when you are not in a hot country. It is advisable to cover up with long sleeves and a hat and wear a good quality factor 50 sunscreen when outdoors.
• Should be taken with food to reduce the risk of nausea and heart burn

Azithromycin or Clarithromycin

• Can cause issues with hearing, tinnitus, balance and palpitations
• these should be discussed before starting medication and you may be recommended to have hearing assessments and a heart tracing (ECG)
• you should tell your doctor if you develop any of these symptoms when taking these antibiotics
• More information on taking these antibiotics long term can be found on our Azithromycin- respiratory medicine leaflet

Ciprofloxacin (along with drugs in the same ‘fluoroquinolone’ class – Levofloxacin and Moxifloxacin)

• has been reported to cause side effects involving tendons, muscles, joints, nerves, or mental health – in some patients, these side effects have caused long-lasting or permanent disability
• you should stop taking your fluoroquinolone antibiotic and contact your doctor immediately if you have any of the following
• tendon pain or swelling – if this happens, rest the painful area until you can see your doctor
• pain in your joints or swelling in joints such as in the shoulders, arms, or legs
• abnormal pain or sensations (such as persistent pins and needles, tingling, tickling, numbness, or burning), weakness in the legs or arms, or difficulty walking
• severe tiredness, depressed mood, anxiety, problems with your memory or severe problems sleeping
• changes in your vision, taste, smell or hearing

Tell your doctor if you have had any of the above effects at any point while taking Ciprofloxacin. This means you should avoid it in the future

Allergies

What is the difference between side effects and an allergy?

All medicines may cause unpleasant side effects such as a skin reactions/rashes, vomiting or diarrhoea. Side effects are different to allergic reactions. Having side effects to an antibiotic, whilst unpleasant, does not mean you need to avoid that antibiotic completely. This is particularly true in severe infections where the antibiotic you have side effects to may actually be the best antibiotic to treat your infection. In these situations it is often best to receive the right antibiotic and manage side effects if they happen.

Allergic reactions

There is a risk of allergic reactions to some medicines. Before starting any new treatment, the clinical team will check if you have had any previous reactions and depending on the medicine, you may be given your first dose during a clinic appointment so you can be observed for any reactions.

Mild to moderate allergic reactions include symptoms such as itch, rash, wheeze or breathlessness. If this happens, contact you GP.

Severe allergic reactions are extremely rare but can be life threatening. Reactions that cause swelling of the throat or mouth (anaphylaxis) are a medical emergency and you should call 999 immediately.

Any new allergic reactions will be documented in your notes to avoid giving you the same or similar treatment again.

Penicillin allergy

Many patients report experiencing allergic reactions to penicillin or have a documented allergy from childhood.

However, did you know that 9 out of 10 people recorded as having an allergic reaction to penicillin do not actually have a true allergy?

Penicillin based antibiotics are very important for treating bronchiectasis exacerbations and so your clinical team may discuss trying treatment with penicillin again under very close observation. This is called ‘de-labelling’. This is important as being able to take penicillin based antibiotics increases the choice of treatment that can be given if you are unwell with an infection.

There is a lot more information about penicillin allergy and penicillin de-labelling on the HIS: Do I have a Penicillin Allergy? leaflet.