“Protect your good bacteria” a comic proposal from Med Student Educational Module

So, this is what happens if you set a Medical Student the task of creating something that communicates an important message in how antibiotics are used….


(And if you’re interested – this isn’t just a fart joke…it’s an evidence-based piece of targeted work!

Poster presented FIS conference, Glasgow, 2015

For the literature behind the comic, read on…)

The message is clear, and fits with existing patient material from available sources:




The delivery of the messages has been specifically designed using an educational exploration of behaviour theory.

It was highly influenced by the work of Lucy Yardley and Sarah Tonkin Crine on the GRACE INTRO study: http://www.ncbi.nlm.nih.gov/pubmed/25030621

And the behaviour change wheel by Susan Michie was used as a basis to consider targets for intervention.  http://www.implementationscience.com/content/6/1/42

The recommendation for the non-antibiotic management of cough is in keeping with national guidelines of best practice:


And the explanation of the harmful effects of antibiotics are based on available knowledge about the effects of antibiotics on the gut microbiome, and antibiotic-associated diarrhoea.

The gut microbiome’s diversity is depleted with antibiotic therapy:


Whilst antibiotic-associated diarrhoea may be due in many cases to osmotic effects, or disturbance of bile salt metabolism, bacteria have been suggested as possible causes – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686956/

Toxin production by C. difficile is mediated by quorum sensing :http://mbio.asm.org/content/6/2/e02569-14.full

And it’s not the only species that can cause toxin-induced antibiotic-associated diarrhoea.  http://www.ncbi.nlm.nih.gov/pubmed/16086721.

In consideration of giving a balanced message, and avoiding the ‘unintended harm’ that it may lead to patients not taking antibiotics when they need them- this is specifically addressed in the text.

It is currently a proposal, rather than a finished object, but any comments or feedback is welcome!  bugsvdrugs@gmail.com is the email address set up for use in our educational modules which we can all use.


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