Prescribing Antibiotics Just Got More Complicated

Tinker Ready, August 10, 2017

No one knows for sure how long a patient should take an antibiotic, new research suggests.

Conventional wisdom is that patients who fail to complete a prescribed course of antibiotics put themselves and others at risk of antibiotic resistance.

But a recent analysis fails to find evidence to support the notion and throws conventional thinking into question.

The World Health Organization endorses the full course of infection-fighting drugs, as do clinical recommendations in Australia, Canada, the United States, and Europe.<

The authors of a recent BMJ analysis point out, however, that in most cases, no one really knows how long a patient should take an antibiotic.

They write that the idea of "stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence. At the same time taking antibiotics for longer than necessary has the opposite effect, increasing the risk of resistance."

Tim E.A. Peto, a professor of infectious disease at Oxford Biomedical Research Centre in Oxford, England, is one of the study's authors. His group contends that there is a need for more evidence on the optimal course of antibiotic treatment.

A competent physician, for example, may have a good sense of an individual patient and know when it makes sense to stop treatment. Others will need guidance.

Peto's team is looking at one approach, instituting a formal review 24 to 48 hours after starting antibiotics, to assess the need to continue.

"What we haven't got is a nice algorithm that people can follow without thinking," he said. "That needs to be developed."

A hospital may have an antibiotic stewardship program, but "there may not be a good evidence base behind what they are prescribing," Peto says.

Tinker Ready

Tinker Ready is a contributing writer at HealthLeaders Media.

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