A group of UK researchers have questioned whether patients should always finish a full course of antibiotics. With antibiotic resistance growing, the study asks whether taking the drugs for a shorter amount of time would necessarily lead to increasing problems with resistance. The scientists are from Brighton & Sussex Medical School, the University of Southampton and the University of Oxford. It was published in the BMJ (British Medical Journal), which is peer-reviewed. You will need to sign up to read the study.
This study is a narrative review which discusses evidence about a chosen topic. There is a risk that such a review could be accused of choosing evidence that mainly supports their hypothesis. The authors have not shown a clear methodology for indicating how they chose which randomised controlled trials and observational cohort studies to use for the study. The authors acknowledge that there have only been a small number of studies which investigate the minimum time needed for antibiotics to work. In some of the trials, the evidence has suggested that a shorter treatment time with antibiotics could lead to a problem with recovery. The advice is also contrary to current advice from the World Health Organisation (WHO).
The authors suggest that the practise of prescribing a fixed number of days for a course of antibiotics may overlook the individuality of patients: some patients will respond differently to the antibiotics depending on the infection. A patient’s previous use of antibiotics is also not often considered, unless they have just finished a course that was not successful.
The idea that finishing a course of antibiotics will reduce antibiotic resistance, has been around for a long time and both doctors and patients are familiar with the idea. To put forward the thought that a shorter course of the drugs may be just as effective, may be difficult for people to grasp. The suggestion is that the patient should only take antibiotics until their own immune system is able to take over the beating of the infection. This does not preclude the knowledge that there are times when antibiotics may be required for a longer length of time, for example, when treating tuberculosis.
The study’s team of scientists suggest that should evidence support it, there could be public health education on antibiotics, to offer simpler messages such as, “Stop when you feel better.” The over use of the drugs by patients is one of the main reasons for antibiotic resistance, and completing a shorter course may help to cut back on antibiotic use. The scientists suggest that prescribing practices do need to change and that current use of antibiotics is unsustainable because of the number of diseases that are becoming resistant to their use.
This study raises some interesting questions and the debate will continue, but this is just one study. If more studies take place, and evidence recommends it, then it is possible that future guidelines will be altered to take note of what has been found in this study. However, until then, patients should continue to follow their GP’s recommendations on how long to take antibiotics and that they remember to finish the whole course if that is what they are asked to do.
Llewelyn MJ, et al., The antibiotic course has had its day, BMJ, July 2017; 358