‘Don’t take full course of antibiotics’
GPS urged to stop telling patients they must finish all their tablets as it is driving up drug resistance
DOCTORS must stop telling patients to finish an entire course of antibiotics because it is driving up resistance to the drugs, a group of eminent specialists has warned.
Experts from bodies including Public Health England and Oxford University have turned the accepted wisdom on its head by advising that, to avoid overuse of drugs, patients should be encouraged to continue taking medication only until they feel better. Current guidance from both the NHS and the World Health Organisation says that it is essential to “finish a course” of antibiotics to avoid triggering more virulent forms of disease.
In an article published by the British
Medical Journal, 10 leading figures in the field said that the public health message was not backed by the evidence and that it should be dropped. They claim the existing advice actually puts the public at greater risk from antimicrobial resistance.
“Historically, antibiotic courses were driven by fear of under-treatment, with less concern about overuse,” said lead author Martin Llewelyn, professor of infectious diseases at the Brighton and Sussex Medical School. “The idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence, while taking antibiotics for longer than necessary increases risk of resistance.
“We encourage policy-makers, educators and doctors to stop advocating ‘complete the course’,” Prof Llewelyn declared.
In the UK, at least 12,000 people die from antibiotic-resistant bugs each year, experts estimate – more than die from breast cancer.
Fears that stopping antibiotics early could trigger drug-resistant mutations of diseases date back to Alexander Fleming, who discovered penicillin in 1928 and later observed that bacteria soon became “acclimatised” and patients taking insufficient doses could then transmit a more dangerous strain to others. In his Nobel Prize acceptance speech in 1945, Fleming warned: “If you use penicillin, use enough.”
However, the BMJ article now argues that when a patient takes any antibiotics it allows dangerous strains of bacteria to grow on the skin and gut which could cause problems later; the longer the course, the more the body’s resistance builds.
Alison Holmes, professor of infectious diseases at Imperial College London, said it was “astonishing” that doctors still did not know the optimum duration for taking drugs even though a long course raises the risk of bacterial resistance.
“The ‘complete the course’ message directly conflicts with the societal messages regarding the changes needed in behaviour and attitudes to minimise unnecessary exposure to antibiotics,” she said.
However, the Royal College of GPS said it was “concerned” about allowing patients to judge for themselves when to stop taking medication. Its chairman, Prof Helen Stokes-lampard, said changing the advice to patients would merely lead to confusion.
“Recommended courses of antibiotics are not random – they are tailored to individual conditions, and in many cases courses are quite short,” she said.
“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.”
Prof Dame Sally Davies, the Chief Medical Officer, said the public message should remain unchanged until there was further research, but that guidance for managing infections was already being looked at by the National Institute for Health and Care Excellence (Nice). Specialists also warned that for some diseases, such as TB, a long course of antibiotics was vital.
Commenting generally, however, Jodi Lindsay, professor of microbial pathogenesis at St George’s, University of London, said: “The evidence for ‘completing the course’ is poor, and the length of the course of antibiotics has been estimated based on a fear of under-treating rather than any studies.”