What if everything you thought you knew about antibiotics was wrong?
Patients have always been told that the key to a safe and effective course of antibiotics is to take all your pills as scheduled, even if you feel better.
But, a new editorial published this week in the British Medical Journal is turning that notion on its head.
Researchers argue that not only is the “complete the course” message unnecessary, it is actively contributing to the growth of antibiotic-resistant bacteria — not preventing it.
“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 study authors wrote.
How the practice got started
The “complete the course” message may have had some merit in the early days of antibiotic development, but largely has not changed since then.
Researchers cited an example from 1941 in which scientists treated a man’s infection with penicillin, only for the infection to eventually reemerge and kill him when doctors ran out of medicine.
Overuse was not a real concern, but undertreatment was. It was considered short courses came with life-threatening risks.
However, doctors are now publicly refuting that notion.
“There was no evidence that this was because of resistance, but the experience may have planted the idea that prolonged therapy was needed to avoid treatment failure,” the study authors wrote.
“It’s great that people are starting to ask that question: ‘Is it OK to stop sooner than we’ve all been led to believe?’” said Dr. Carl Olden, a family physician speaking on behalf of the America Academy of Family Physicians (AAFP).
“Even for the folks who actually need antibiotics because of the bacterial infection, we know there is a downside to antibiotic exposure,” Olden told Healthline.
Antibiotic-resistant bacteria is considered a major global health threat, but at the same time antibiotics are being prescribed more than ever.
According to the Centers for Disease Control and Prevention (CDC), roughly 1 in 3 antibiotic prescriptions outside of a hospital setting are unnecessary.
Total “inappropriate” antibiotic use, which includes incorrect dosing and duration, is nearly 50 percent.
How long is long enough?
Researchers say that the “complete the course” message is a “fallacious belief” that actively works against responsible use of antibiotics. But, it is still too early to change that message.
There is an acknowledged lack of data on the ideal “minimum effective treatment” for antibiotics, but with new research conducted with randomized controlled trials, this could be determined.
“I wish we had great data about how long is long enough, and is it OK to shorten courses, because I think a lot of us have always hoped that we could get by with shorter courses,” said Olden.
Moving forward with promoting shorter courses will prove difficult in several ways.
The first phase is to establish research to show what is a minimum effective dose for different kinds of antibiotics.
The second phase concerns how to best promote that message. Part of the appeal of the “complete the course” message has been its simplicity.
Doctors would have to convey a message to patients that is both safe and effective.
A message such as “take until you feel better,” is somewhat ambiguous and could create problems in an outpatient setting.
“What people are tolerant of in terms of symptoms can matter,” said Olden. “Maybe I can deal with coughing and aching, but not fever or phlegm.”
Beyond that exact message, however, both Olden and the study authors agree that the general public must become more informed and judicious about antibiotic use.
“Try to get by without antibiotics,” said Olden. “Expect shorter courses, and always ask ‘Is it necessary for me to take an antibiotic?’”