Dilemma of double dosing 

Jane is a 30-year-old woman who is 35 weeks pregnant with her first child. She attends her antenatal appointment at the hospital and has a routine urine MCS test done by the midwife. The test results show that she has a urinary tract infection (UTI) caused by E. coli, which is sensitive to amoxicillin. The local policy states that the obstetric team or midwifery team should review the results and action them. If the patient needs antibiotics, they should contact the patient and prescribe the antibiotics. The results also go to Jane’s GP, Dr. Smith. Dr. Smith is aware of the local pathway, but he does not know if the results have been actioned by the hospital. He is concerned about Jane’s health and the risk of complications for her and her baby if the UTI is left untreated. He is also aware that double prescribing can lead to antibiotic resistance and adverse effects. He is faced with a dilemma: should he prescribe antibiotics for Jane or wait for the hospital to do so?

• How did Jane react when she learned about her UTI? Did she express any concerns or preferences about taking antibiotics?

•  What are the advantages and disadvantages of prescribing antibiotics for Jane from Dr. Smith’s perspective? What are the potential harms and benefits for Jane and her baby?

• What are the ethical principles that guide Dr. Smith’s decision-making? How does he balance Jane’s autonomy and best interests?

• What are the legal and professional implications of double prescribing for Dr. Smith? How does he document his actions and rationale?

Ethics case