When a patient is prescribed a course of antibiotics, they are always cautioned against stopping the medication before the course has been completed. While it’s been believed that early discontinuation of antibiotics could help drive antibiotic resistance among pathogens, a new paper published in the BMJ suggests that this idea is outdated.
The researchers point out that this belief is not supported by scientific evidence and that physicians should change their prescribing habits for antibiotics in light of this. In fact, the researchers say that longer courses of antibiotic treatment unnecessarily expose patients to a higher risk of developing antibiotic resistant bacteria.
“Public communication about antibiotics often emphasizes that patients who fail to complete prescribed antibiotic courses put themselves and others at risk of antibiotic resistance,” said Dr. Martin J. Llewelyn, professor of infectious diseases in the Department of Global Health and Infection, Brighton and Sussex Medical School, and his colleagues in the publication. “However, the idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence, while taking antibiotics for longer than necessary increases the risk of resistance.”
Llewelyn and his colleagues demonstrate how ingrained the idea of “completing the course” is in modern medicine by sharing guidance posted by the World Health Organization (WHO) during Antibiotic Awareness Week in 2016. The health authority encouraged patients to “always complete the full prescription, even if you feel better, because stopping treatment early promotes the growth of drug-resistant bacteria.”
They also explain that standard durations for antibiotic treatment have been historically driven by making sure patients were not undertreated. In an age where growing worries surrounding antibiotic resistance threaten our future ability to treat infectious diseases, doctors should strive to address overuse of these drugs through lengthy courses of antibiotics. Many doctors may be aware of overprescribing antibiotics to patients who may not need them, however little emphasis is currently put on how long those patients are taking the medication.
“For most indications, studies to identify the minimum effective treatment duration simply have not been performed,” write the researchers. “For the opportunist pathogens for which antimicrobial resistance poses the greatest threat, no clinical trials have shown increased risk of resistance among patients taking shorter treatments.”
Llewelyn and his co-authors advocate for a more individualized approach to antibiotic prescribing practices, which takes into account a patient’s history of antibiotic exposure along with using biomarkers to help inform clinicians about a patient’s response to treatment. The researchers say that these individual factors have largely been ignored in the medical community, with physicians relying upon the antibiotic course duration standards with little supporting evidence.
“Daily review of the continued need for antibiotics is a cornerstone of antibiotic stewardship in hospitals, but in primary care, where 85% of antibiotic prescriptions are written, no such ongoing assessment is attempted,” said the researchers.
In addition to changes made to antibiotic prescribing behavior among physicians, and the messages that are broadcast to patients regarding completing a course of the drugs, Llewelyn and his colleagues also say that more clinical trials are needed to determine the minimum effective doses for commonly-prescribed antibiotics.