You shouldn’t always take full course of antibiotics

Experts say taking drugs after you feel well may encourage rise of superbugs

DOCTORS should stop telling patients to complete their courses of antibiotics, say experts.

They fear that continuing with a course of treatment after a patient feels better could increase antibiotic resistance – where superbugs evolve that are immune to drugs.

Their advice flies in the face of World Health Organisation guidelines, which tell patients to complete antibiotic courses even after they start to feel well again.

For years, GPs have told patients that failing to finish a course is ‘irresponsible’ as it could increase antibiotic resistance and they urged caution over the new report.

Professor Helen Stokes-Lampard, chairman of the Royal College of GPs, said patients should not change their behaviour ‘based on one study’.

The report from ten specialists in infectious diseases from Oxford University and Brighton and Sussex Medical School said the current advice is not backed up by evidence. Instead, they say there is evidence that stopping antibiotics sooner is a safe and effective way to reduce overuse of the drugs.

Professor Martin Llewelyn, the report’s lead author, said: ‘Historically, antibiotic courses were set by precedent, driven by fear of under-treatment, with less concern about overuse… Completing the course goes against one of the most fundamental and widespread medication beliefs people have, which is that we should take as little medication as necessary.’

Antibiotic resistance is a global health crisis, with overuse of antibiotics a main driver, because bacteria become more resistant the more frequently they are used and develop into superbugs.

Writing in the BMJ journal, Professor Llewelyn and colleagues said: ‘The fallacious belief that antibiotic courses should always be completed to minimise resistance is likely to be an important barrier to reducing unnecessary antibiotic use.’ They added: ‘Patients may respond differently to the same antibiotic. Currently, we largely ignore this fact and instead make… recommendations for antibiotic duration that are based on poor evidence.’

In hospitals, patients are often treated with antibiotics only until tests show they have recovered from infection.

The study’s authors said: ‘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. The public should be encouraged to recognise that antibiotics are a precious and finite natural resource that should be conserved.’

For the research, experts analysed results of multiple reliable studies on antibiotics. They found shorter courses of around half the length normally prescribed had no impact on whether the patient recovered, became re-infected or died. Certain antibiotics were best taken over longer periods, such as those used to treat tuberculosis. But others, such as those for pneumonia, could be just as effective over shorter courses.

The authors said more trials were needed to establish what advice should be given to patients about how long to take the drugs.

Professor Stokes-Lampard said: ‘Recommended courses of antibiotics are not random – they are tailored to individual conditions and, in many cases, courses are quite short.

‘We are concerned about the concept of patients stopping taking their medication midway through a course once they “feel better”, because improvement in symptoms does not necessarily mean the infection has been completely eradicated.’

Public Health England said patients should continue to follow their doctor’s advice.

‘Advice based on poor evidence’