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No need to complete antibiotics course, study says

Doctors’ orders to 'complete the course' for some antibiotics may be wrong, and patients should stop treatment when they feel better, according to an article in a medical journal.
course

Doctors orders to 'complete the course' for some antibiotics may be wrong, and patients should stop treatment when they feel better, according to an article in a medical journal.

Calling for the 'complete the course' instruction for some antibiotics to be ended, the article in the British Medical Journal (BMJ) argues that the warning given to patients at the start of treatment is not supported by the evidence.

Martin Llewelyn at Brighton and Sussex Medical School and colleagues say patients are put at unnecessary risk from antibiotic resistance when treatment is given for longer than necessary, not when it is stopped early.

But the government's chief medical officer, Dame Sally Davies, said the current message to the public remains the same people should always follow

Doctors’ orders to 'complete the course' for some antibiotics may be wrong, and patients should stop treatment when they feel better, according to an article in a medical journal.

course
For most indications, no studies have been carried out to identify
the minimum effective treatment duration. Picture: PA

Calling for the 'complete the course' instruction for some antibiotics to be ended, the article in the British Medical Journal (BMJ) argues that the warning given to patients at the start of treatment is not supported by the evidence.

Martin Llewelyn at Brighton and Sussex Medical School and colleagues say patients are put at unnecessary risk from antibiotic resistance when treatment is given for longer than necessary, not when it is stopped early.

But the government's chief medical officer, Dame Sally Davies, said the current message to the public remains the same – people should always follow the advice of healthcare professionals.

Variable response

The authors of the BMJ study say that traditionally antibiotics are prescribed for recommended treatment courses, and fundamental to this concept is the notion that a shorter treatment would be more inferior.

But they say that for most indications, no studies have been carried out to identify the minimum effective treatment duration.

The complete the course notion ignores the fact that different patients respond to treatments in different ways, they said, adding: 'Currently, we largely ignore this fact and instead make indication-specific recommendations for antibiotic duration that are based on poor evidence.

'This situation is changing in hospital practice, where biomarkers of treatment response can guide when to stop antibiotic treatment.

'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 World Health Organization advice.'

Precious resource

For common bacterial infections no evidence exists that stopping antibiotic treatment early increases a patient's risk of resistant infection, the experts said.

Reducing unnecessary antibiotic use is essential to mitigate antibiotic resistance, they argued, adding that antibiotics are a precious and finite natural resource which should be given to each patient with a tailored treatment duration.

They say research is needed to determine the most appropriate simple alternative messages, such as 'stop when you feel better'.

Commenting on the paper, Royal Pharmaceutical Society spokesperson Kieran Hand said: 'This opinion article from respected NHS infection experts is a welcome opening of the debate in the UK on the relationship between the length of a course of antibiotics, efficacy and resistance.

Ideal scenario

'As the researchers have pointed out, further research is needed before the 'finish the course' mantra for antibiotics is changed and any alternative message such as 'stop when you feel better' can be confidently advocated.

Dr Hand added: 'The ideal future scenario would be that the right length of treatment for a specific infection for patients is identified from clinical trials and the exact quantity needed is prescribed and dispensed.'

About 700,000 people worldwide die each year due to drug-resistant infections.

Professor Davies said: '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.'

She added that the Department of Health will continue to review the evidence on prescribing and drug-resistant infections.


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