Controversial call to scrap 'complete the course' guideline for antibiotics

  • Controversial call to scrap 'complete the course' guideline for antibiotics

Controversial call to scrap 'complete the course' guideline for antibiotics

However, GPs have indicated they do not intend to remove advice to patients to finish their antibiotics, as "changing this will simply confuse people" and could cause patients to fall ill again, because an improvement of symptoms does not always mean an infection has been eradicated.

Doctors have historically told patients that they must complete their course of antibiotics to lower the risk of developing a resistance to the drug.

Andrei Osterman, a professor of bioinformatics who studies the specific mechanisms of bacterial resistance at the Sanford Burnham Prebys Medical Discovery Institute in La Jolla, said he agrees that administering antibiotics for longer than necessary does, indeed, cause collateral damage to the body's microbiome - which can provide a home for drug-resistant bacteria to grow.

Dr. Julie Roth, chair of the family medicine department for Sharp Rees-Stealy Medical Group in San Diego, said while she and others at the organization may prescribe antibiotics for periods as short as one day, patients should not take articles like the one in BMJ as indications that they should stop their regimen when they think they're feeling better.

"Outside hospital, where repeated testing may not be feasible, patients might be best advised to stop treatment when they feel better, in direct contradiction of WHO (World Health Organisation) advice".

The authors added that no evidence happened because of antibiotic resistance, but the experience may have created the idea that prolonged therapy was necessary to avoid treatment failure. While the authors note that further evidence is needed to completely "drop" the message, they suggest an alternative advice of "stopping antibiotics when you feel better".

Maybe you can just stop taking those antibiotics once you start feeling better after all.

Regarding ear infections, for example, one study showed that patients taking an antibiotic for five days were more likely to fail treatment than those taking it for the full 10 days.

A new analysis claims that finishing a course of antibiotics is unnecessary and it could increase the risk of antibiotic resistance. "For some infections, like TB, it is critically important to complete the treatment course, because, as has been demonstrated all too many times, not doing so promotes antimicrobial resistance in TB and recurrence of infection". The reason we obey doctors' orders is that they have access to more and better information than we do. (The CDC reported past year that 1 in 3 antibiotic prescriptions in the USA were unnecessary).

Prof Llewelyn added: "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".

"Recommended courses of antibiotics are not random". "My thought is that this is a radical stance-although in some ways correct", says Lance Price, a microbiologist and director of the Antibiotic Resistance Action Center at The George Washington University. "Fundamental to the concept of an antibiotic course is the notion that shorter treatment will be inferior". However, there is no clear methodology so we don't know how the evidence was chosen and whether it was systematic in manner.

But Professor Helen Stokes-Lampard, chair of the RCGP, said that "we can not advocate widespread behaviour change on the results of just one study". At the beginning of the antibiotic era, the danger to patients came from insufficient dosage, not from too much.

Public Health England said: "We continue to recommend patients follow their health professional's advice on antibiotics". They wrote that a common practice in hospitals-a daily review of a patient's continued need for antibiotics-must become more common in primary care as well, because that is where some 85 percent of prescriptions are written.