Patients should stop taking antibiotics when they feel better, experts say

  • Patients should stop taking antibiotics when they feel better, experts say

Patients should stop taking antibiotics when they feel better, experts say

They fear that continuing with a course of treatment after a patient feels better could increase antibiotic resistance - where superbugs evolve that are immune to drugs.

Over time, excessive use of antibiotics could lead to minor infections causing serious health complications, making surgery and treatment for diseases such as cancer much riskier.

In an article in the British Medical Journal, they said that, in many cases, there have been no studies to work out the minimum effective course of treatment.

In a new analysis in the BMJ, health experts from Brighton and Sussex Medical School, the University of Oxford and other institutions say that the idea that cutting short a course of antibiotics will encourage drug resistance is not supported by evidence.

Professor Stokes-Lampard added that while antibiotic resistance was one of the biggest global challenges, "we can not advocate widespread behaviour change on the results of just one study".

There are some diseases where the bug can become resistant if the drugs are not taken for long enough.

Those numbers are expected to increase significantly in the coming years.

When [Australian pharmacologist] Howard Florey's team treated [British police constable] Albert Alexander's staphylococcal sepsis with penicillin in 1941 they eked out all the penicillin they had (around 4 [grams], less than one day's worth with modern dosing) over four days by repeatedly recovering the drug from his urine.

Instead he said that the message that needed to be emphasised was that under treatment leads to treatment failure, but over or unnecessary treatment leads to resistance.

Pete explained in an interview that as far as they could tell, the "full course" idea originated with a speech in 1945 given by Nobel Prize victor Alexander Fleming.

But that idea is outdated, say Llewelyn and his colleagues in the BMJ commentary. They cite previous trials to suggest courses of antibiotics lasting three to five days may be just as effective as longer courses at eradicating most bacteria, like E. coli, though they acknowledge more studies need to be done.

There are notable exceptions for some types of antibiotic, such as those used to treat tuberculosis.

They called for research to determine the most appropriate, simple, alternative message, such as stop when you feel better.

You might be rolling your eyes at this, but a group of "eminent specialists" have once again turned medical advice on its head, suggesting patients don't necessarily need to complete a full cycle of antibiotics.

Still, Tamma - also an assistant professor of pediatric infectious diseases at Johns Hopkins - noted that there is a historic basis for "prolonged" antibiotic courses, especially before widespread concern about antibiotic resistance. "This collateral selection is the predominant driver of the important forms of antibiotic resistance affecting patients today". The longer the antibiotic exposure these bacteria are subjected to, the greater the pressure to select for antibiotic resistance.

"The public should also be encouraged to recognise that antibiotics are a precious and finite natural resource that should be conserved by tailoring treatment duration for individual patients", the researchers added.

If there were a battle hymn against antibiotic resistance, it would have one common refrain: Every inappropriate prescription or insufficient dose strengthens the enemy.

Meanwhile, Kieran Hand, spokesman for the Royal Pharmaceutical Society, said: "This opinion article from respected NHS infection experts is a welcome opening of the debate in the United Kingdom on the relationship between the length of a course of antibiotics, efficacy and resistance".

"We don't want, in some instances, to cause patients to have a relapse in their infection", he said. The reasons given are that this will stop the infection from returning, as well as reduce the risk of the bacteria becoming resistant to the antibiotics.

So, continue to follow your doctor's orders regarding antibiotics, but know that the idea that everyone needs to "complete the course" is just another in a long line of medical dogmas that is based on weak evidence and is likely to change.