For decades, it was thought that completing a course of antibiotics may help prevent resistance – a piece of non-evidence-based advice. Recent studies have instead suggested that patients should cease consumption of antibiotics upon symptomatic improvement.

However, conventional guidelines still recommend that patients should complete a full course of antibiotics to prevent the development of resistant strains of bacteria. Critics have also said that it is difficult to change this recommendation in the context of insufficient evidence.

This creates confusion amongst patients and doctors alike, therefore, Dr Sujatah Raman, Associate Professor in Science and Technology Studies at the University of Nottingham and Dr Warren Pearce, Faculty Fellow (iHuman) at the University of Sheffield have suggested for scientists to step in to clear the air.

Taking the antibiotic consensus as an example

“Evidence provided by science is often mixed, incomplete, changeable or conditional on context. Yet, experts are expected to stick to narratives that highlight a consensus view,” they wrote in an article for The Conversation.

“Simplifying the complex may be essential for public communication; but this is not the same as glossing over uncertainty or valid disagreements,” they added.

They attributed the role of scientists in medicine to be particularly important because of their ability to conduct large-scale research involving animal or human trials and draw reasonable conclusions.

Therefore, when an article published in the British Medical Journal in July 2017 suggested that primary care patients prescribed antibiotics for common bacterial infections could be stopped when they feel better – critics feared the public would be confused by the study.

The World Health Organisation (WHO) also stated in the Global Action Plan, that information regarding antibiotic usage must be made available in a transparent fashion to the general public to prevent overuse.

Experts are therefore advised to convey a simple message as uncertainty creates anxiety – making patients unsure of what to believe or how to act. Additionally, conflicting opinions within the healthcare industry can also generate confusion in patients who wish to know which advice is reliable.

The challenge of accepting uncertainty


The role of scientists in medicine to be particularly important because of their ability to conduct large-scale research involving animal or human trials and draw reasonable conclusions.
The role of scientists in medicine to be particularly important because of their ability to conduct large-scale research involving animal or human trials and draw reasonable conclusions.

However, health communication scholars did point out that this is too simplistic as people manage and respond to uncertainty in different ways. Some may ignore the debates, relying on their familiar beliefs instead, whereas others may find open discussion more reassuring as it aligns with their own instincts about knowledge.

Evidence is also not a substitute for judgement as scientific research done to address complex matters may even increase uncertainty as new evidence poses further questions. Nonetheless, research needs to be done to determine which clinical practices are both clinically and economically viable.

For instance, in the case of antibiotic prescription, if excess antibiotics are being prescribed, valuable healthcare resources could end up depleted. Following historical practices may not necessarily be efficacious and therefore, scientists are a critical component of the healthcare framework.

Whilst scientific research may increase, clinical discretion exercised by physicians is still essential. Large-scale systematic reviews may still have a degree of uncertainty associated with them.

Adding to the uncertainty, result may vary as defining traits and disease characteristics vary between participants in clinical trials. Credibility is also challenged when new knowledge challenges current consensus.

Accepting uncertainty in the healthcare industry is indeed challenging, but it is likely to increase over time with novel research findings. Perhaps it is better to communicate why evidence may be inconclusive and why experts make reasonably different judgements on the same problem.

For whether antibiotic regimens should be revised or not, it can be agreed that more research is needed to justify the necessity of patients continuing to be on antibiotics long after their symptoms have ceased. MIMS

Read more:
Deadly drug-resistant Japanese fungus detected in UK hospitals
WHO: Gonorrhoea becoming incurable and harder to treat globally
Completing a course of prescribed antibiotics may not prevent antimicrobial resistance, new study shows

Sources:
https://consumerist.com/2017/08/24/doctors-finally-prescribing-fewer-antibiotics-but-continue-prescribing-unnecessary-antibiotics/
https://theconversation.com/why-we-should-expect-scientists-to-disagree-about-antibiotic-resistance-and-other-controversies-82609
http://www.bmj.com/content/358/bmj.j3418
https://www.ncbi.nlm.nih.gov/books/NBK11740/