I am writing in reply to CH Ong's letter . I do not feel that there is a need to explain my position on antibiotic abuse. As in my previous letter , I do agree that this problem needs to be tackled.

Nevertheless encouraging the Malaysian public to take legal action, in my opinion, is unwise. Lest of course, individuals like CH Ong would like to pay extra on his next medical assessment. I did not in any way object to the ministry taking action on doctors found to be abusing antibiotics but that in itself will not solve anything.

Filling in as a locum puts doctors at an odd position. We are holding another doctor's business venture in trust temporarily. CH Ong must understand that private clinics are business ventures and competition is stiff. I do agree that this should not be the reason for abusing antibiotics but realistically, pleasing your customers and ensuring their satisfaction remains an important business target It is prevalent worldwide where privatisation of healthcare exists.

This no doubt compounds the problem of antibiotic resistance in a population that still do not understand the fundamentals of antibiotic treatment. There is however no easy solution.

There is a fine line of what constitutes antibiotic abuse. Prescribing antibiotics for extended viral infections is acceptable as there is a possibility of a superimposed bacterial infection. The decision of starting antibiotics still lie solely with the discretion of the doctors involved. I think the correct terminology should not be abuse of antibiotics but rather over-treatment with antibiotics. Unless we swab and culture all our patients with infections, we cannot accurately determine a viral or bacterial aetiology in infections although clinical assessment will provide a clue and the fact that most upper respiratory infections are viral in origin.

For example, a child coming in with a temperature and looks unwell is often prescribed an antibiotic although it still most likely is a viral infection. Even a child with breathing difficulties, commonly caused by viral infections, are usually over-treated with antibiotics. The cases go on and on.

Prescribing antibiotics to an insistent patient is controversial. He may not be happy when an antibiotic has not been prescribed and may be under the impression that he has been under-treated with medications that he could have easily bought from the pharmacy himself. Most individuals that visit a private clinic come with expectations of getting an antibiotic. Meeting these expectations is a daily challenge for doctors. Some patients accept the explanations easily while others can be threatening when such expectations are not met.

Moreover, doctors can never confirm a viral aetiology and can only treat using a "best guess" theory. Prescribing an antibiotic is often seen as a safe measure of covering both grounds more so

in an insistent patient. So CH Ong, the situation is not as straight forward as you have suggested.

I have digressed due to CH Ong's inaccurate, incomplete and careless assessment of the situation. It was an unwarranted and a convenient attempt at discrediting an honest opinion that the health minister should not in his capacity as such, encourage individuals to take legal action without first analysing this complex situation.