Complete the antibiotics course, or drop out when you feel better?

27 Jul 2017

Image: Regreto/Shutterstock

A recent study hinted at ending courses of antibiotics sooner, but is that really in a patient’s best interests?

Antibiotic resistance is a worrying issue. As recently as this month, the World Health Organisation (WHO) warned that drug-resistant gonorrhoea was a growing concern.

Last summer, Irish research into this sphere found two plant-based candidates that could be pivotal in the fight against antibiotic resistance: broad beans and cowpeas, which may be the answer to humanity’s sickly prayers.

Elsewhere, researchers at Ulster University have developed a new mobile diagnostics device that works on the spot – another angle at fighting the resistance.

Drop the slogan

However, a study published yesterday (26 July) in The British Medical Journal argued that the belief that patients should complete the course of medication to avoid antibiotic resistance is not backed by evidence and should be dropped.

In fact, patients are put at unnecessary risk from antibiotic resistance when treatment is given for longer than necessary, not when it is stopped early, according to Prof Martin Llewelyn at Brighton and Sussex Medical School, along with colleagues.

The thinking behind the study sways more towards doctors prescribing the right amount of antibiotics, and how that should improve, though patient-directed advice is suggested.

“Outside hospital, where repeated testing may not be feasible, patients might be best advised to stop treatment when they feel better, in direct contradiction of WHO advice,” reads the paper.

Too subjective?

This is a statement that many are concerned by, leading to plenty of discussion on the topic, with healthcare professionals quick to warn against taking the study too literally.

“The suggestion that patients should stop taking antibiotics ‘when they feel better’ is too subjective,” said Prof Dilip Nathwani, president of the British Society for Antimicrobial Chemotherapy (BSAC).

“At best, [it] will lead to a potential stockpiling of unused antibiotics for future use without first seeking the advice of a doctor, and at worst, inappropriate use that would almost certainly contribute to a rise in antibiotic resistance rates.

“The evidence they offer in support of their call is sparse and their advice is potentially very confusing for patients,” said Nathwani, though the BSAC is “open to further debate” on the subject.

Prescribed course of action

Dr Nuala O’Connor of the Irish College of General Practitioners told Newstalk that stopping antibiotic courses when patients feel better is the wrong message to send out.

“What it is, is that you should take the course of antibiotics as prescribed and that doctors need to be careful that they only prescribe the necessary course of antibiotics for a particular patient for a particular condition.”

Prof Helen Stokes-Lampard, chair of the Royal College of General Practitioners, said antibiotic courses are “tailored to individual conditions”, rather than just random decisions.

Still, the authors of yesterday’s study argue that clinical trials are required to determine the most effective strategies for optimising duration of antibiotic treatment.

Gordon Hunt was a journalist with Silicon Republic