Should Patients Take the Full Course of Antibiotics?

New research calls into question long-accepted guidelines for antibiotic use.

When prescribed antibiotics, healthcare professionals advise patients to take the full course of the medication to ensure that the infection is properly treated. Non-adherence to this standard has been thought to have contributed to the rise of antibiotic-resistant superbugs.

In contradiction to traditional guidelines, findings from a new study published by BMJ suggest that completing a course of antibiotics may not be necessary. The authors said that the recommendations should be revised to reflect current scientific findings.

The authors suggest that patients may be at risk of developing antibiotic resistance from longer-term treatment opposed to when it is stopped early, according to the study.

“While the ‘complete the course’ message is one we all know, we have found that it is time for this message to change,” said lead study author Martin J Llewelyn, PhD. “The belief that stopping antibiotic treatment increases the risk of antibiotic resistance is not supported by evidence. In fact, this risk is actually increased by taking antibiotics for longer than is necessary.”

Antibiotics are crucial for the health of patients around the world, but the growing prevalence of antibiotic-resistant bacteria poses a threat to public health. Reducing antibiotic overuse has been a target of numerous campaigns to lessen the impact of drug resistance.

The authors argue that the standard concept of not stopping antibiotics until the full course is completed may not be supported by scientific evidence; however, exposing patients to longer courses of antibiotics may increase the likelihood of developing resistance.

In the study, the investigators noted that the first instance of advocating for long courses of antibiotics was when a patient treated with shorter courses of penicillin was observed to transmit a drug-resistant infection in the 1940s. The authors wrote that the bacteria evolved because of target selected resistance.

While target selected resistance occurs due to inadequate antibacterial treatment or monotherapy for infections that spontaneously become resistant, the authors state that bacteria that currently pose a threat do not typically develop resistance through this mechanism, according to the study.

Bacteria, such as Escherichia coli and ESKAPE organisms, are opportunistic pathogens that take hold in vulnerable patients. These bacteria are currently driving drug-resistant infections.

For these reasons, the authors challenge the belief that longer treatment with antibiotics are more effective compared with shorter treatments. Additionally, there is little evidence that recommended doses are a minimum, below which patients would be less likely to be cured of the infection, according to the study.

“For the opportunist pathogens for which antimicrobial resistance poses the greatest threat, no clinical trials have shown increased risk of resistance among patients taking shorter treatments,” the authors wrote.

Antibiotic treatment may vary on a patient level due to previous exposure to certain antibiotics and individual response to therapy; however, current guidelines do not account for these factors, according to the study.

In certain hospitals, healthcare providers can test for specific biomarkers to determine if antibiotic treatment can be stopped, but this practice may not be feasible in other clinical settings, according to the study.

The authors call for policymakers, educators, and physicians to revise strategies used to treat bacterial infections.

“Although the ‘complete the course’ message is clear and simple to follow, it is time that we promote a more effective way of reducing antibiotic overuse,” Dr Llewelyn concluded. “Further research is needed to find a new message that works for the public, such as ‘stop when you feel better.'"