A new analysis claims that finishing a course of antibiotics is unnecessary and it could increase the risk of antibiotic resistance. The study, named “The antibiotic course has had its day,” was published on Wednesday in the British Medical Journal.
The British researchers stressed the need for policy makers, educators, and doctors to deliver the message that completing a prescribed antibiotic course contributes to antibiotic resistance.
They noted that little evidence backs the “complete the course” suggestion given to patients for taking antibiotics and that it is “fallacious.” While the authors note that further evidence is needed to completely “drop” the message, they suggest an alternative advice of “stopping antibiotics when you feel better.”
Finishing antibiotic courses may increase risk of antibiotic resistance
The authors also admitted that their suggested advice might not apply to all infections.
“We’re not all saying that patients should stop when they feel like it or that patients should ignore their doctor’s advice,” said Tim Peto, co-author of the analysis and professor of medicine at the University of Oxford, according to CNN.
However, Peto said that ending a course of antibiotics to prevent resistance is a “counter-intuitive” view, backed with little evidence. Overall, he believes that there’s not enough information for doctors to know how long antibiotics should be prescribed for.
“Historically, antibiotic courses were set by precedent, driven by fear of undertreatment, with less concern about overuse,” wrote the researchers, who were led by Martin Llewelyn of Brighton and Sussex Medical School. “There is, however, little evidence that currently recommended durations are minimums, below which patients will be at increased risk of treatment failure.”
Last year, a study determined that doctors were overprescribing patients with antibiotics. In a review of prescriptions handed from 2010 to 2011, the researchers found that 262 million patients were prescribed antibiotics in that time frame, suggesting that at least 30 percent of those prescriptions were unnecessary.
Lengthy antibiotic courses may have originated in the dawn of the antibiotic era
According to the Centers for Disease Control and Prevention, antibiotic resistance affects around 2 million people in the U.S. and kills more than 23,000 each year. Unnecessary prescriptions cause most of these cases.
The authors of the new analysis believe that recommendations for antibiotic durations come from poor evidence that can be traced back to the dawn of the antibiotic era after penicillin entered in the 1940s.
“When Howard Florey’s team treated Albert Alexander’s staphylococcal sepsis with penicillin in 1941 they eked out all the penicillin they had over four days by repeatedly recovering the drug from his urine,” wrote the authors. “When the drug ran out, the clinical improvement they had noted reversed and he subsequently succumbed to his infection.”
The authors added that no evidence happened because of antibiotic resistance, but the experience may have created the idea that prolonged therapy was necessary to avoid treatment failure.
The analysis concludes by saying that more research is needed to establish the most appropriate message when it comes to antibiotic treatment duration and that public education should highlight that antibiotic resistance is the result of overuse and that it can’t be prevented by completing a course.
Source: The BMJ