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Study contradicts widely held belief on length of antibiotics use

Published on 27/07/17 at 09:46am

If you’ve ever taken a course of antibiotics then you will be familiar with the piece of advice that is often handed out alongside the prescription – to make sure you complete the full course of the antibiotics. A new study emerged, published in the BMJ has countered this by suggesting that this direction is not based on evidence.

The study actively argues against the “complete the course” mantra, suggesting that patients should instead stop taking the medication when they feel back to full health. The researchers suggest that the long-held belief to fully complete a course of antibiotics has been held under the presumption that this was the safest route to ensure that mutations in bacteria did not occur.

Now, they postulate that this may be the exact opposite of what would happen – with longer courses ensuring that bacteria are unnecessarily exposed to antibiotics, increasing the opportunity for them to mutate.

The researchers recommend that shorter courses should be delivered to patients and that the length of the regimen should be determined by the evidence, either on existing data or by undertaking clinical trials to better evaluate this.

At the heart of the debate is the growing threat of antibiotic resistance, as more evidence emerges from around the world of the growing inefficacy of many forms of antibiotics, including so called ‘last-resort’ antibiotics.

Professor Helen Stokes-Lampard, Chair of the RCGP, responded to the study: “We are concerned about the concept of patients stopping taking their medication mid-way through a course once they ‘feel better’, because improvement in symptoms does not necessarily mean the infection has been completely eradicated. It’s important that patients have clear messages and the mantra to always take the full course of antibiotics is well known – changing this will simply confuse people.”

She continued, conceding that: “We agree with the researchers that more high quality, clinical trials are needed – and when guidelines are updated, they should take all new evidence into account. But we’re not at that stage yet.”

The concern about stopping medicine through treatment would be of concern in certain areas specifically noted by the study. For instance, in TB infections, stopping a course of antibiotics without fully clearing the disease is known to cause mutations in the bacteria.

The researchers behind the study noted this worry and suggested that regimens should be determined for such individual cases. It also suggests that for common bacterial infections there has been no evidence to suggest that stopping antibiotic treatment early has any risk in the increase of resistant infection.

The study concluded: “Antibiotics are a precious and finite natural resource which should be conserved by tailoring treatment duration for individual patients.”

Ben Hargreaves

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