There are serious concerns that the world faces a global health security threat from antimicrobial resistance. The overuse of antibiotics is thought to be a major danger, increasing the chance that bacteria will evolve the ability to overcome even our best medicines.
Yet patients given a course of antibiotics to treat an infection are customarily told by their doctors that they should complete the entire course, even if they feel better mid-way through. The logic is that if you take too few, the bacteria can mutate and develop resistance.
This is at odds with what many scientists thought, however, as it basically increases the patient's exposure to the antibiotics for a longer period of time and encourages the overuse of antibiotics. Now, a professor in infectious diseases, Martin Llewelyn, and his colleagues are claiming that the advice is wrong.
Writing an analysis of the approach to always continue your course of antibiotics in the British Medical Journal, the researchers state that “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.”
The analysis calls for more research to look into exactly what impact stopping antibiotics once you feel well will have on patients. While there are some infections where the drugs should certainly be used for extended periods, such as with TB, there are many cases in which the fewer antibiotics used is better.
“I have always thought it to be illogical to say that stopping antibiotic treatment early promotes the emergence of drug-resistant organisms,” says the President of the British Society for Immunology, Peter Openshaw, who was not involved in this analysis, in a statement. “This brief but authoritative review supports the idea that antibiotics may be used more sparingly, pointing out that the evidence for a long duration of therapy is, at best, tenuous.”
It is thought that the ideal length that someone should take antibiotics varies from individual to individual. It can be influenced by how effective your immune system is, as well as by what antibiotics you have taken in the past. Either way, for the time being, you should always listen to what your doctor recommends.
“Ideally, there should be clinical trials to support the duration of therapy, but in the meantime it should be up to the prescriber to recommend how long to continue treatment," added Openshaw.
Professor Llewelyn concludes: “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.”