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antibiotic resistance

An About-Face in Antibiotic Treatment Recommendations

Stopping a course of antibiotics early might be a good thing

A group of doctors and scientists are challenging the deeply embedded medical message that patients should “complete the course” of antibiotics to avoid antibiotic resistance. That recommendation regarding antibiotic treatment is not backed by evidence and should stop being the standard advice from physicians, experts argue in a paper published in The BMJ, a respected, peer-reviewed medical journal.

In fact, the opposite is true: Patients are put at unnecessary risk from antibiotic resistance when treatment is given for longer than necessary, not when it is stopped early, say Professor Martin Llewelyn, of Brighton and Sussex Medical School, and colleagues. They are calling for policy makers, educators, and doctors to drop issuing this message when prescribing antibiotics and to disabuse patients of the widely accepted advice.

The Swaddle reported last year on the rising incidence of antibiotic-resistant bacteria in India, interviewing doctors who gave the recommendation — standard at the time, and now — that patients should always complete the full course of antibiotics they are prescribed; failing to do so, the doctors said, allows some bacteria to survive following exposure to the medication, thus making the antigens more resistant to the same medication in the future.

However, that idea is not supported by evidence, explain the paper’s authors; instead, there is evidence that taking antibiotics for longer than necessary increases the risk of resistance.

While the old recommendation of taking a complete antibiotic course is clearly defined and easy to carry out, the authors say there is evidence that, in many situations, stopping antibiotics sooner is a safer and more effective way to reduce antibiotic overuse. (They note exceptions for some types of antibiotics, such as those used to treat tuberculosis, which should always be taken in full.)

Perhaps as importantly, the experts argue, completing a full course of antibiotics goes against one of the most fundamental and widespread medical beliefs: that we should take as little medication as necessary.

The experts calling for research to determine the most appropriate and simplest alternative messages (such as ‘stop when you feel better’) and for clinical trials to determine the most effective strategies for optimising duration of antibiotic treatment.

Until new recommendations are issued, consult your doctor, and follow her prescription. But it seem that, when it comes to antibiotics, as with most things in life, sometimes less is more.

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