Do patients really need to take their full course of antibiotics? 4 thoughts

Physicians should stop instructing patients to take the full course of antibiotics, according to an analysis published in The BMJ.

There is no evidence to suggest stopping antibiotic treatment prematurely spurs greater resistance, according to Martin Llewelyn, PhD, a professor of infectious diseases at the University of Sussex in England, and his team of colleagues.

In the analysis, the researchers analyzed the history of antibiotic courses and assess whether their benefits outweighed the risks.

Here are four takeaways.

1. Antibiotic courses stemmed from a fear of undertreatment. Current antibiotic prescribing practices follow the fundamental belief that shorter treatment periods will be inferior. However, there is "little evidence that currently recommended durations are minimums, below which patients will be at increased risk of treatment failure," the researchers wrote.

2. Longer antibiotic treatment increases resistance. The largest clinical bacterial threat comes from common "opportunistic pathogens," like E. coli and Staphylococcus aureus, which are found all over our environments. When patients take antibiotics, these antibiotic-sensitive species and strains are replaced by more resistant bacteria ready to cause future infections.

"This collateral selection is the predominant driver of the important forms of antibiotic resistance affecting patients today," the researchers said. "The longer the antibiotic exposure these opportunist bacteria are subjected to, the greater the pressure to select for antibiotic resistance."

3. Shorter treatment periods pose less risk for patients. The researchers cited randomized controlled trial data, which showed shorter treatment with antibiotics for hospital-acquired pneumonia had equivalent outcomes to longer treatment courses and resulted in lower rates of infection recurrence and antibiotic resistance.

4. Physicians should tailor antibiotic treatment for each patient. Not all individuals will respond the same way to an antibiotic, since they have different patient and disease factors. Physicians should prescribe antibiotic courses on a case-by-case basis, according to the report. While researchers noted further studies are needed to evaluate this practice, they highlight one such clinical trial that found stopping antibiotics when a pneumonia patient's fever resolved cut average treatment duration in half without hindering clinical success.

"The public should be encouraged to recognize that antibiotics are a precious and finite natural resource that should be conserved," researchers concluded. "This will allow 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."

To view the full analysis, click here.

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