Feel better? Maybe you don't need to finish those antibiotics after all

Maybe you can just stop taking those antibiotics once you start feeling better after all.

It turns out the common, dire warning from physicians that a sometimes lengthy course of antibiotic treatment must be completed to save the world from developing antibiotic resistance is not supported by scientific evidence, a researcher says.

Not only that, Martin Llewelyn, a professor in infectious diseases at Britain's University of Sussex, writes with colleagues in an article for the British Medical Journal that taking antibiotics for longer than necessary increases the risk of developing a resistance.

Antibiotics are used around the world for a wide range of bacterial illnesses from strep throat to blood stream infections. Antibiotic resistance occurs when bacteria change and become resistant to the antibiotics used to treat the infections they cause. It's already happening, and it has been a critical problem for some time.

Just this month, the World Health Organization reported antibiotic resistance is causing gonorrhea to become more difficult, and in some cases impossible, to treat. 

Llewelyn notes the U.S. Centers for Disease Control and Prevention has already eased back slightly from the WHO warning, replacing the “complete the course” mantra with messages advocating taking antibiotics “exactly as prescribed.”

Lauri Hicks, director of the CDC's Office of Antibiotic Stewardship, says that can be difficult to get right. A hospitalized patient's progress can be monitored hourly. But someone who walks into a physician's office with strep throat is generally given a 10-day course of treatment. The patient might feel better after a few days, but perhaps shouldn't stop taking the meds without seeing the doctor again.

"There are a number of infections for which we don't have sufficient evidence to support an ideal length of therapy," Hicks said. "Another consideration is that every single individual is different."

 

Hicks office this week released a report on antibiotic use in the U.S. The report notes antibiotic resistance is "one of the most serious public health problems in the United States and threatens to return us to the time when simple infections were often fatal."

Llewelyn agrees that resistance is a crucial problem. And he agrees that bacterial change can compromise the ability to treat infectious diseases and damage the value of some medicinal advances. 

But Llewelyn calls out the prestigious WHO, which sponsored a World Antibiotic Awareness Week in November. At issue is the WHO claim that "if you take an antibiotic, always complete the full prescription, even if you feel better, because stopping treatment early promotes the growth of drug-resistant bacteria."

Llewelyn disagrees, writing this "fallacious" belief is more likely a barrier to reducing unnecessary antibiotic use and to developing scientific evidence to determine proper antibiotic use.

"The idea is deeply embedded, and both doctors and patients currently regard failure to complete a course of antibiotics as irresponsible behavior," Llewelyn writes.

WHO did not immediately respond to USA TODAY's request for comment. Hicks lauded Llewelyn and his colleagues for tackling the issue but called it "complicated."

Llewelyn, however, is adamant.

"We ... encourage policy makers, educators, and doctors to stop advocating 'complete the course' when communicating with the public," Llewelyn writes. "Further, they should publicly and actively state that this was not evidence-based and is incorrect."

© 2017 USATODAY.COM


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