A patient in his late 30s presented to an MDU GP member complaining of a cough that had lasted for two weeks. Our member prescribed a one week course of phenoxymethylpenicillin at 500mg four times a day, which the patient was somewhat cautious about accepting because he thought he was allergic to penicillin.

Our member checked thoroughly through the records and noted several mild gastrointestinal upsets to various different penicillin-based antibiotics, but nothing to suggest the patient was allergic. He advised the patient of what to do in case of an allergy but continued to give the penicillin antibiotic with generalised advice in dealing with upper respiratory tract infections.

The patient started the course of phenoxymethylpenicillin and soon became concerned; he had been unwell with doxycycline in the past and had developed a mild rash to it. He became increasingly anxious and went back to our member, who reassured him but advised that he could try taking the penicillin at double dose twice daily instead of four times daily.

The patient managed two more days of antibiotics - four days in total - before presenting to A&E with a distressing panic attack, complaining to the presenting doctor that he was finding it difficult to breathe and that this was exactly what he thought would happen given his previous reaction to an antibiotic.

The A&E doctor treated the patient with antihistamines, advised him to stop the antibiotic and sent him home. The patient became increasingly upset over what had happened and shortly afterwards the member received a request for records followed by a letter of claim from the patient's solicitor.

The claim

The claim alleged that the member had ignored the patient's concerns about being allergic and that he hadn't paid enough attention to the records, prescribing an antibiotic he knew would cause an allergy. It also alleged that he should never have used an antibiotic in the first place for a likely viral infection, and that he should have prescribed just one dose of antibiotic to test if the patient was allergic. It was implied that as a result, the patient had suffered a panic attack and became increasingly anxious in the weeks since his treatment, although he had made a full recovery from his respiratory tract infection.

The MDU investigated the claim by requesting a full set of records from the GP and a copy set of the hospital records from the patient's solicitors, and we also sought our member's factual statement and comments on the letter of claim. Our member advised that he was aware the patient had dealt with periods of anxiety in the past and that there was no documentation in the records that suggested the patient was actually allergic to penicillin and that he had only had a reaction to doxycycline.

MDU response

A letter of response denying liability was drafted and issued to the patient's solicitors. The MDU advised that penicillin was not in the same class of antibiotics as doxycycline and there was no evidence that it had caused any kind of allergy at all.

The MDU apologised on behalf of our member for any distress caused but reassured the claimant's solicitor that the GP member had given the penicillin with careful thought and that there was no reason to think either before or after the incident an allergic reaction had occurred.

After two months the claimant's solicitors wrote to say they were dropping the claim in light of the MDU's robust response; the member was delighted with the outcome.
