No evidence to support benefits of ‘finish the course’ antibiotic advice

It’s time to call an end to the “complete the course” message for some antibiotics, according to an article in a leading medical journal.

Experts writing in The British Medical Journal (The BMJ) argue that the warning given to patients at the start of treatment is not supported by the evidence.

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

They say that traditionally antibiotics are prescribed for recommended treatment 0 Warning is in direct contradiction to WHO advice courses and fundamental to this concept is the notion that a shorter treatment would be more inferior. They add that for most indications, studies to identify the minimum effective treatment duration simply have not been performed.

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 WHO (World Health Organisation) advice.”

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