It has been a well-established practice for healthcare professionals to recommend that patients complete their course of prescribed antibiotics. This is not only essential to ensure that the infection is fully cleared; but also to prevent the development of resistant strains of bacteria.

Nonetheless, recent developments have highlighted that completing a course of antibiotics may not always be beneficial – in terms of decreasing resistance of microorganisms to treatment.

Antibiotic regimens may need to be altered

According to health experts, as mentioned in the British Medical Journal (BMJ) – the fact that completion of a course of antibiotics may prevent antibiotic resistance is not supported by robust scientific evidence.

The risk of antibiotic resistance developing is greater when antibiotic intake is ceased later than the recommended date as opposed to stopping the course earlier. Finishing a recommended course of antibiotics is still endorsed by important health authorities, such as the National Health Service (NHS) and the World Health Organisation (WHO).

Guidelines by these bodies state that it is imperative to “finish a course” of antibiotics in order to prevent the development of more harmful variants of the disease. Infections complicated by resistant microorganisms include tuberculosis and HIV infections, which have a combined mortality rate of about 700,000 per year, globally.

One approach towards antibiotic prescription may not suit all patients

A lot of these findings stem from early usage of antibiotics; for instance, Alexander Fleming, discovered the utility of penicillin in treating a variety of infections resulting from Streptococci and Meningococci.

The blanket approach towards antibiotic prescription means that every patient is advised to take an antibiotic for a specific fixed duration. While this may be beneficial in certain cases, this approach condones the fact that individuals might respond to treatment at different rates with some patients recovering more quickly than others.

Utilising antibiotics even after a patient feels physically better and notices an improvement in their symptoms may not be very beneficial in terms of preventing antibiotic resistance. This is particularly in view of such scenarios when antibiotics are prescribed for illnesses that do not require antibiotic treatment; for instance, viral infections which typically resolve with appropriate rest and hydration.

Following current guidelines on antibiotic usage may be essential

An important counter argument postulated by physicians is that changing the guidelines for antibiotic regimes will only serve to confuse patients. It is also not reliable to solely depend on the patient’s physical symptoms. Even if a patient feels physically better, continuing antibiotic treatment may be essential to ensure the infection is completely cleared.

Professor Stokes-Lampard, chair of the Royal College of GPs, comments on the difficulty of incorporating these new findings into clinical practice, further stating that “we cannot advocate widespread behaviour change on the results of just one study.”

However, in some cases, adhering strictly to the antibiotic regimen prescribed is imperative – for example, for infants afflicted by cytomegalovirus (CMV) infection. Taking the antibiotic as prescribed is not only important to prevent recurrence – it also reduces probability of complications and transmissions of the infection to other individuals.

Dr Sharon Meropol, paediatrician at Case Western Reserve Hospital states that, “For this reason, patients should still follow their physicians’ advice on the duration of antibiotic therapy.”

In the analysis published in the BMJ, it is expressed that, “The message ‘complete the course’ has persisted, despite not being supported by evidence and previous arguments that it should be replaced.”

It is essential to see whether the course of antibiotic prescription and the advice doctors give to their patients changes in the light of this new found evidence. MIMS

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