Time May Be Up for 'Finish the Course' Antibiotics Message
The widely promoted idea that stopping antibiotics too soon creates antibiotic resistance and could breed deadly superbugs is wrong and should be replaced, researchers say.
The age-old admonition for patients to “complete the course” of antibiotics prescriptions is not backed by evidence and should be replaced, according to an analysis published in The BMJ.
Sparking controversy, the authors challenge the message—backed by the World Health Organization and U.S. Centers for Disease Control and Prevention--to “always complete the full prescription, even if you feel better, because stopping treatment early promotes the growth of drug-resistant bacteria.”
To the contrary, patients are put at unnecessary risk from antibiotic resistance when treatment is given for longer than necessary, not when it is stopped early, according to Professor Martin Llewelyn at Brighton and Sussex Medical School and colleagues.
“Historically, antibiotic courses were set by precedent, driven by fear of undertreatment, with less concern about overuse. For many indications, recommended durations have decreased as evidence of similar clinical outcomes with shorter courses has been generated,” they wrote.
“For most indications, studies to identify the minimum effective treatment duration simply have not been performed,” noted the article.
What researchers do know today is that many variables affect a person’s response to antibiotics, including the pathogen being treated and previous exposure to antibiotics.
While hospitals have updated practices to monitor patients for biomarkers and stop antibiotics when no longer needed, more research is needed to arrive at appropriate new instructions for patients to follow at home, such as “stop when you feel better.”
One of the reasons the “complete the course” mantra has held so well is that it’s simple and easy to carry out, noted the researchers.
In order to change public thinking, the medical profession must buy into the idea that the old advice is wrong and engage in more patient-centered decision-making around antibiotics. One leverage point in discussing the idea with patients is that “completing the course” runs counter to most people’s belief that they should take as little medication as necessary.
“Concerted and consistent efforts have successfully educated the public that antibiotics do not treat viral infections,” the authors noted.