July 27, 2017 -- The message given by doctors to "complete the course" when taking antibiotics should be dropped, experts say.
They argue that it is not backed by evidence and should be replaced.
Antibiotics are important for fighting off infections, but there is a growing global concern about the number of cases in which bacteria have become resistant to these medicines.
So that more germs don't build up a resistance to antibiotics, it's important that the drugs not be used unless they're needed.
The current recommendation by the World Health Organization (WHO) is to "always complete the full prescription, even if you feel better, because stopping treatment early promotes the growth of drug-resistant bacteria.”
But several experts in infectious diseases are urging policymakers, educators, and doctors to reconsider the advice given to patients when prescribing antibiotics.
Martin J Llewelyn, a professor of infectious diseases at Brighton and Sussex Medical School, and his colleagues have made their case against the “complete the course” message in an article published in the BMJ medical journal.
They say that there is no evidence that stopping antibiotics early encourages antibiotic resistance -- and that taking them for longer than needed makes resistance more likely.
Antibiotic Resistance
In their article, the authors say concerns about not taking enough antibiotics leading to resistance in treatment first occurred in the 1940s.
Alexander Fleming's 1945 Nobel Prize acceptance speech, for example, included his view that if not enough penicillin is given for a streptococcal throat infection, a resistant form of the infection could be passed on to another person. It turned out that the streptococcal bacteria responsible for throat infections have yet to develop a resistance to penicillin.
It is true that for certain infections -- such as tuberculosis, gonorrhea, and malaria -- when the germs causing the infection replicate, antibiotic-resistant mutations can happen if not enough antibiotic is given during treatment or only one medicine is used. This is known as targeted selection. But most bacteria do not develop resistance through targeted selection.
Instead, taking antibiotics can affect the usually harmless flora, or germs, that are normally found on our skin and membranes or in our guts, which lets resistant species or strains replace them. This is known as collateral selection. The longer these opportunistic species or strains are exposed to antibiotics, the authors argue, the more of a chance that antibiotic resistance can happen.
Continued
Llewelyn and his colleagues say that there are some cases, such as ear infections, where a shorter treatment may not be as effective, and that clinical trials can help show the best length of antibiotic treatment.
Llewelyn and his colleagues suggest disregarding the WHO advice and replacing it with advice to stop treatment when the patient feels better. They say that in one clinical trial, stopping antibiotics for treating pneumonia when the patient's fever went down cut the average length of antibiotic treatment in half and did not affect recovery.