Medicine

Experts call for scrapping of antibiotics 'complete the course' message

Experts call for scrapping of antibiotics 'complete the course' message

ANTRUK aims to raise sufficient funds over the next five years to bring at least one new antibiotic therapy to market by the early 2020's.

Telling patients to stop taking antibiotics when they feel better may be preferable to instructing them to finish the course, according to a group of experts who argue that the rule long embedded in the minds of doctors and the public is wrong and should be overturned. But now doctors are saying that that advice has no basis in evidence.

Despite good evidence for shorter courses of antibiotic treatment, Schaffner cautions that sometimes it's going to be necessary to take all of a prescription antibiotic. Though patient-directed advice is suggested. But completing an antibiotic course is against the most fundamental belief that humans should take as little drugs as possible.

The authors of the piece make the point that when antibiotics were first used during the 1940s, there was little awareness of the problems of antibiotic resistance, so the concept of "over-use" was never even considered.

"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 overseas on this issue".

How did the idea of "completing the course" come about?

"No one has questioned (this advice) for all this time", said Peto.

Indeed, in his acceptance speech for the 1945 Nobel Prize in Physiology or Medicine (which he shared with Florey), the Scottish biologist and discoverer of penicillin, Alexander Fleming warned, "If you use penicillin, use enough!"

It has now been shown that the bacteria Fleming named in his tale, Streptococcus pyogenes, never actually developed resistance to penicillin, casting his hypothesis further into doubt. We know antibiotics are not smart bombs or snipers-they do not target only one desired body part like the bladder, as we would like. People fall ill only when the bug gets into the bloodstream or the gut.

Existing recommendations are largely based on clinical trials, says Helen Boucher, a professor of medicine and infectious diseases at Tufts Medical Center and a spokesperson for the IDSA. "And so there's a slight information vaccuum".

It may in fact be best for people to stop taking the drugs when they feel better, wrote a team of researchers in the British Medical Journal (BMJ).

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Such action is needed, they say, because evidence is also building that the longstanding complete-the-course antibiotic message is contributing to drug-resistance bacteria. "Therefore, the overall message to conserve precious antibiotics is simple and important".

Changing standard prescribing practices will likely be challenging, the commentary's authors acknowledge, pointing to the "finish your drugs" education in United Kingdom schools.

"In the scientific world, it's an accepted view that there is too much usage of antibiotics and we want to minimize that".

"In many previously healthy patients with acute infections, letting them stop the antibiotics once they feel better has considerable appeal".

The researchers say that some diseases such as tuberculosis can become resistant if the drugs are not taken for long enough - but this is not the case with most illnesses.

So should you complete the course or not?

Patients have always been advised to finish their course of antibiotics even if they're feeling better.

Professor Helen Stokes-Lampard, chairman of the Royal College of Global Positioning System, said patients should not change their behaviour "based on one study".

"Recommended courses of antibiotics are not random".

"Rather than trying to change patient perceptions around completing the course ... more work is required around defining appropriate minimum course lengths, and this can then be used to inform prescribers", he added.

'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".