Complete the antibiotics course, or drop out when you feel better?

Phillip Cunningham
July 27, 2017

But until any changes are announced, it is a good idea to take your antibiotics as prescribed, even if you are feeling better.

"What it is is that you should take the course of antibiotics as prescribed and that doctors need to be careful that they only prescribe the necessary course of antibiotics for a particular patient for a particular condition".

The authors, writing in a BMJ Analysis article, state that the clinical threat of antibiotic resistance stems mainly from opportunistic pathogens, such as S. aureus and Pseudomonas - bacteria that are usually harmless but can opportunistically cause disease. Alexander Fleming's early work showed that sensitive bacteria could be "acclimatized" to penicillin, and in 1945, he spoke about a man who didn't take enough of the drug and passed strep throat-now in a drug-resistant form-onto his wife, who died from the infection.

The report from ten specialists in infectious diseases from Oxford University and Brighton and Sussex Medical School said the current advice is not backed up by evidence.

An analysis in the British Medical Journal by United Kingdom experts in infectious diseases, microbiology and health psychology, who are working to tackle antimicrobial resistance, recommends that, outside hospital, where repeated testing is not feasible, patients should be advised to stop antibiotic treatment as soon as they feel better. This deeply embedded message is being put into question by a group of United Kingdom experts in a research analysis published Wednesday in the British Medical Journal on Monday.

Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh, agreed that doctors' advice to patients needs to change.

It has been widely accepted that stopping antibiotic treatment early encourages bacteria to develop antibiotic resistance.

So in other words, shortening a course of antibiotics to the bare minimum to fight the illness might be the best way to minimise the risk of resistance.

Numerous bacteria that are prone to causing risky antibiotic-resistant infections, such as Staph aureus and E coli, live on the body harmlessly without causing a problem most of the time.


Public communication about antibiotics often emphasises that patients who fail to complete prescribed antibiotic courses put themselves and others at risk of antibiotic resistance.

Prof Llewelyn added: "Although the "complete the course" message is clear and simple to follow, it is time that we promote a more effective way of reducing antibiotic overuse".

"The authors have sown the seed of suspicion that the "finish the course" mantra does not stand up to scientific scrutiny but they have quite rightly pointed out that further research is needed before an alternative message such as "stop when you feel better" can be confidently advocated", he said.

"What this paper really calls for is a full-fledged effort in our research studies to understand when is it necessary to complete a certain course of antibiotics and when is it not - in fact, when it might even be advisable to do a short course", Osterholm said.

Professor Llewellyn says, 'Historically, antibiotic courses were driven by fear of undertreatment, with less concern about overuse.

The patient may think an infection is gone but it could still be there at a level they cannot feel, he added.

Lauri Hicks, director of the Office of Antibiotic Stewardship at the CDC, says she agrees that there are many unanswered questions about appropriate drug treatment courses.

This review raises some interesting points and the guidelines around antibiotic treatments may change in the future.

The one rule about antibiotics that has been drilled into our heads for generations is that you absolutely must take the full course - or else something very bad might happen. We need to start to use antibiotics more wisely before it's too late.

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