Brighton, UK—Pharmacists have said it so many times, they probably don’t even think about it: “Be sure to take all of the antibiotics in the bottle.”
Now, British infectious disease experts are suggesting that those instructions be dropped. Why, according to an article in the British Medical Journal?
The authors from the Brighton and Sussex Medical School argue that there is little evidence that failing to complete a prescribed antibiotic course contributes to antibiotic resistance.
“The ‘complete the course’ message has persisted despite not being supported by evidence and previous arguments that it should be replaced,” study authors point out. “One reason it may be so resilient is that it is simple and unambiguous, and the behavior it advocates is clearly defined and easy to carry out. Nevertheless, there is evidence that, in many situations, stopping antibiotics sooner is a safe and effective way to reduce antibiotic overuse.”
The researchers add that hospitals reassess antibiotic need daily, but that doesn’t occur in primary care, where 85% of antibiotic prescriptions are written.
Their position goes strongly against conventional wisdom. In materials supporting Antibiotic Awareness Week 2016, the World Health Organization advised patients to “always complete the full prescription, even if you feel better, because stopping treatment early promotes the growth of drug-resistant bacteria.”
On the other hand, while current public information materials from the CDC and Prevention and Public Health England don’t explicitly contradict that advice, these agencies instead recommend that antibiotics be “exactly as prescribed,” according to the report.
Essentially, the authors make four points:
• Prolonging antibiotic treatment, not stopping it early, puts patients at unnecessary risk from antibiotic treatment.
• No evidence exists for common bacterial infections that stopping antibiotic treatment early increases the risk of resistant infection.
• Treatment duration should be tailored to individual patients because antibiotics are a finite natural resource that should be conserved.
• Not enough clinical trials have been conducted to determine optimal duration of antibiotic treatment.
“The key argument for changing how we discuss antibiotic courses with patients is that shorter treatment is clearly better for individual patients,” the authors argue. “Not only does an individual patient’s risk of resistant infection depend on their previous antibiotic exposure but reducing that exposure by shorter treatment is associated with reduced risk of resistant infection and better clinical outcome. In hospital acquired pneumonia, for example, randomized controlled trial data indicate that short treatment strategies have equivalent clinical outcomes to longer courses and are associated with lower rates of infection recurrence and antibiotic resistance.”
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