NEW YORK (Reuters Health) – There is little evidence that failing to complete a prescribed course of antibiotics contributes to antibiotic resistance, and it’s time for policymakers and doctors to drop this message, infectious disease experts from the UK argue in a new paper.
“In day-to-day clinical practice, where we are treating opportunist pathogens, the idea that stopping antibiotic treatment early increases risk of antibiotic resistance is incorrect and is a barrier to using antibiotics better,” first author Dr. Martin Llewelyn, from Brighton and Sussex Medical School, told Reuters Health by email. “It’s a barrier to reducing antibiotic use both in the individual prescribing decisions doctors make and to doing research to develop antibiotic sparing treatment approaches.”
Antibiotic resistance is a “global, urgent threat to human health,” Dr. Llewelyn and colleagues note in their paper, online July 26 in the BMJ, and curbing unnecessary antibiotic use is key to combating antibiotic resistance.
In 2016, the World Health Organization (WHO) advised patients to “always complete the full prescription, even if you feel better, because stopping treatment early promotes the growth of drug-resistant bacteria.” Similar advice appears in national campaigns in Australia, Canada, the United States, and Europe.
“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,” write Dr. Llewelyn and colleagues.
Current public information materials from the US Centers for Disease Control and Prevention (CDC) and Public Health England (PHE) have replaced “complete the course” with statements advocating taking antibiotics “exactly as prescribed.”
“Some media coverage since the (BMJ) article has suggested we are against current CDC and PHE advice to take antibiotics as prescribed,” Dr. Llewelyn told Reuters Health. “We are not arguing with this advice which is common sense and allows doctors and patients to have a proper discussion about when treatment should stop.”
Dr. Llewelyn added, “While ‘stop when you feel better’ may be right in some situations, we are not encouraging this as a new approach generally. We are advocating, as we say in the paper: ‘….patient centered decision making about antibiotic treatment, where patients and doctors can balance confidence that a complete and lasting cure will be achieved against a desire to minimize antibiotic exposure unimpeded by the spurious concern that shorter treatment will cause antibiotic resistance.’”
The authors say one reason the “complete the course” message has persisted despite little support and previous arguments that it should be replaced is that it’s “simple and unambiguous, and the behavior it advocates is clearly defined and easy to carry out.”
“Nevertheless, there is evidence that, in many situations, stopping antibiotics sooner is a safe and effective way to reduce antibiotic overuse,” they write. Their analysis, they say, is based on published, good-quality randomized clinical trials and observational cohort studies.
“Research is needed,” they conclude, “to determine the most appropriate simple alternative messages, such as stop when you feel better. Until then, public education about antibiotics should highlight the fact that antibiotic resistance is primarily the result of antibiotic overuse and is not prevented by completing a course. The public should be encouraged to recognize that antibiotics are a precious and finite natural resource that should be conserved.”