Is ‘completing the course’ to prevent antibiotic resistance a myth?

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The well-recognised message that patients should ‘complete the course’ of antibiotics in order to avoid the emergence of antibiotic resistance is not supported by evidence, according to new research.

The article, published recently in the British Medical Journal, has reported that patients are put at unnecessary risk from antibiotic resistance when treatment is given for longer than is necessary. In addition, the analysis argues that policy makers, doctors and educators should resign this misleading message as it is “not evidence-based and is incorrect”.

The report compiles evidence reporting that, in many situations, stopping antibiotics sooner is a both safe and effective way to reduce antibiotic overuse. This is due to collateral selection – the longer opportunistic, and often commensal, bacteria are exposed to antibiotics, the greater the pressure to select for antibiotic resistance. However, the authors do state there are some exceptions, for example the antibiotics used to treat tuberculosis.

Completing the course is also at-odds with one of the most fundamental medical beliefs that we should take as little medication as necessary. In addition, the concept overlooks the fact that patients may respond differently to medications, depending on diverse factors.

The article calls for additional research to investigate the most appropriate alternative messages, and also states that clinical trials will be required to determine the most effective antibiotic strategies for optimizing treatment.

Chief Medical Officer for the UK, Prof Dame Sally Davies, commented: “The message to the public remains the same: people should always follow the advice of healthcare professionals. To update policies, we need further research to inform them.

“[The National Institute for Health and Care Excellence] is currently developing guidance for managing common infections, which will look at all available evidence on appropriate prescribing of antibiotics.

“The Department of Health will continue to review the evidence on prescribing and drug-resistant infections, as we aim to continue the great progress we have made at home and abroad on this issue.”

Sources: Llewelyn MJ, Fitzpatrick JM, Darwin E et al. The antibiotic course has had its day. BMJ. 358, j3418 (2017); www.eurekalert.org/pub_releases/2017-07/b-ttd072517.php

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