‘Complete the course’ may be harmful: experts

"The length of the course of antibiotics has been estimated based on a fear of under-treating rather than any studies." Professor Jodi Lindsay, University of London

BRITAIN: It is a mantra followed by patients around the world: always complete the full course of antibiotics, even if the ailment is long forgotten. Now specialists have warned that such advice is not backed by evidence, and could be increasing drug resistance.

Doctors could instead tell patients to stop taking medication when they feel better, British experts have written in the latest issue of The BMJ.

Martin Llewelyn, of Brighton and Sussex Medical School, and nine colleagues from universities across the country have urged health officials and school biology teachers to ‘‘stop advocating ‘complete the course’ ‘‘ and to ‘‘publicly and actively state that this was not evidence-based and is incorrect’’.

GP leaders have voiced concern that changing the simple message could cause confusion, however, and are urging patients to keep following the advice.

Antibiotics are used to treat conditions such as severe acne, kidney infections and pneumonia, but many patients stop their courses early, despite warnings that under-treated bacteria will turn resistant.

In the BMJ article, the infection experts warn that the length of most antibiotic courses - typically three to 10 days - is not based on good clinical studies, meaning that patients may be taking them for longer than they need to. This raises the risk of antibiotic resistance and goes against the principle that people should take as little medication as necessary.

Tim Peto, professor of medicine at the University of Oxford and one of the authors, said: ‘‘If we compare it with something like heart disease, there is a huge evidence basis for treatment ... but for the use of antibiotics, duration of treatment, there is very little evidence.’’

Jodi Lindsay, professor of microbial pathogenesis at St George’s, University of London, said: ‘‘Evidence for ‘completing the course’ is poor, and the length of the course of antibiotics has been estimated based on a fear of undertreating rather than any studies.’’

Antibiotic resistance is a growing threat. Dame Sally Davies, Britain’s chief medical officer, has warned that society faces an ‘‘apocalyptic’’ scenario in which common infections are fatal and treatments from hip replacements to chemotherapy become impossible. Up to 50,000 people are estimated to die each year in Europe and the United States from antibiotic-resistant infections.

Helen Stokes-lampard, chairwoman of the Royal College of GPS, said: ‘‘Improvement in symptoms does not necessarily mean the infection has been eradicated. The mantra to always take the full course of antibiotics is well known - changing this will simply confuse people.’’

Davies said people should always follow the advice of healthcare professionals.

- The Times