By Glenn Ellis
A recent commentary published in the British Medical Journal reignited the debate on whether patients should stop antibiotics when they feel better rather than following instructions to finish the course.
So why all the fuss? And is it safe to stop early? The reason for the fuss is that the world is facing a public health crisis because resistance to antibiotics is on the rise.
As to the second question: based on current evidence, no it’s not.
But first to the fuss. Bacteria that were once easily treated with antibiotics are now increasingly able to resist their action so that they no longer work. The situation has become so serious that we are literally running out of antibiotics that still work for many common bacterial infections such as urinary tract infections and infections acquired in hospital.
For some, no antibiotics are left that will kill the bacteria causing the infection. This has profound implications for the treatment and prevention of common bacterial infections, particularly in patients more likely to get them. These include people undergoing surgery and those whose immune systems are weakened by chemotherapy, HIV, diabetes, chronic diseases and transplantation. It puts these groups at greater risk of severe illness and death.
As to why you should finish the course: there are three reasons why you should, based on the fact that one size doesn’t fit all and that a subjective feeling of “being better” doesn’t necessarily mean that the infection is adequately treated.
First, not all bacterial infections are created equal. Based on our current knowledge, some infections caused by bacteria can be treated with short courses of antibiotics, but others have a much higher return of the infection if not treated with a longer course.
Second, not all antibiotics are created equal. There are a number of different types which doctors use to treat the same types of infection, and some require longer courses than others.
Third, science isn’t up to speed on how long courses should be. This is because knowledge about how particular antibiotics deal with particular bacteria in particular infections, and how those bacteria respond, is work in progress.
Concern has also been raised that stopping early may lead to people keeping unused antibiotics to use in the future without direction by a doctor or nurse, or sharing them with family or friends when they are sick. Each of these scenarios could lead to harm to the person and increase resistance rates through unnecessary use.
Doctors have long urged patients to adhere strictly to antibiotic prescriptions, asserting that the entire course should be completed regardless of whether their symptoms have been resolved. Not doing so, conventional wisdom has held, brings the risk of increasing bacterial resistance to antibiotics.
Antibiotic resistance is one of the most serious global threats to both human health and agriculture, and finding ways to avoid it is a priority. When it comes to treatment for our bacterial infections, it has long been thought that cutting a course short eradicates most but not all of the bacteria behind the illness, thus leaving the door open for the pathogens to develop the ability to evade attack by the drugs.
Recently, that approach has been called into question.
The researchers urge doctors, educators and policy makers to drop the “complete the course” message and communicate with patients that the longstanding way of thinking is incorrect. For common bacterial infections, for example, no evidence exists that stopping antibiotic treatment early increases a patient’s risk of resistant infection.
Their main argument for changing how doctors discuss antibiotic courses with patients is that shorter treatment can be better for individual patients. Not only does an individual patient’s risk of resistant infection depend on his/her previous antibiotic exposure, but reducing that exposure via shorter treatment is associated with reduced risk of resistant infection and better clinical outcome, they say.
Traditionally, antibiotics are prescribed for recommended durations or courses. Fundamental to the concept of an antibiotic course is the notion that shorter treatment will be inferior.
Concern that giving too little antibiotic treatment could select for resistance can be traced back to 1941, when Howard Florey’s team treated Albert Alexander’s staphylococcal sepsis with penicillin. They stretched out all the penicillin they had over four days by repeatedly recovering the drug from the patient’s urine. When the drug ran out, the clinical improvement they had noted reversed, and he subsequently succumbed to his infection. As the researchers note in their new study, there was no evidence that this was because of resistance, but the experience may have planted the idea that prolonged therapy was needed to avoid treatment failure. Experts pointed out that for some diseases, such as tuberculosis, a long duration of antibiotics is vital.
Antibiotic resistance is a growing public health concern worldwide. Whatever you do, check with your doctor before starting or stopping taking antibiotics…
Remember, I’m not a doctor. I just sound like one.
Take good care of yourself and live the best life possible!
The information included in this column is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan.
Glenn Ellis, is a Health Advocacy Communications Specialist. He is the author of Which Doctor?, and Information is the Best Medicine. For more good health information, visit: www.glennellis.com