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Antibiotic treatment duration

Portfolio politics

Louise Newson

Wednesday, 09 August 2017

antibioticsIt has always been tradition that when prescribing antibiotics to patients that we inform them how important it is to complete the course of their antibiotics. There has been concern in the past that failure to prescribe the complete course of antibiotics can put patients and also others at risk of antibiotic resistance.

However, since I qualified as a doctor over 20 years ago, the recommended duration of a course of antibiotics has reduced for some infections, for example, uncomplicated urinary tract infections and respiratory tract infections.

A recent article in The BMJ (BMJ 2017; 358:j3418) discusses whether we should change our practice regarding this. The notion that stopping antibiotics early increases the risk of resistance is not supported by clear evidence and publication material from the US Centers for Disease Control and Prevention (CDC) and Public Health England now states that antibiotics should be taken “as prescribed” rather than “completing the course”.

There have not been any trials which have shown that there is an increased risk of resistance for patients taking shorter courses of antibiotics. An individual patient’s risk of resistant infection is reduced by taking antibiotics for a shorter length of time and there may even be a better clinical outcome by being associated with a lower risk of infection recurrence.

However, we should be mindful that is should not always be the individual patient’s decision regarding appropriate length of course for their antibiotics to treat their infection. Antibiotic treatment, including the length of it, has to stay a professional decision and cannot be left to the patient. 

The main reason to give antibiotics is not to prevent development of resistance but to offer our patients the most effective treatment. Patients with certain infections, including sepsis, complicated urinary-tract infections and cellulitis should finish the full course of antibiotics to avoid relapse or other complications. 

We should also be carefully considering the actual need for antibiotics. Reducing inappropriate antibiotic prescribing results in safer, more effective and more cost efficient antibiotic treatment to those patients in need. Doing this will also reduce resistance development.

So, in summary, it may be preferable to advise patients to stop taking their antibiotics when they feel better. This may therefore reduce future antibiotic resistance while minimising antibiotic exposure. Surely this is a positive outcome?

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Louise Newson

Louise is a part-time GP in Solihull, as well as a writer for numerous medical publications, including www.patient.info. She is an Editor and Reviewer for e-learning courses for the RCGP. She is an Editor for Geriatric Medicine journal and the British Journal of Family Medicine. Louise has contributed to various healthcare articles in many different newspapers and magazines and is the spokesperson for The Information Standard. She has also done television and radio work. Louise is a medical consultant for Maverick TV and has participated regularly in ‘Embarrassing Bodies Live from the Clinic’. Louise has three young children and is married to a consultant urological surgeon. Although her spare time is limited she enjoys practising ashtanga yoga regularly and loves road cycling – she has raised over £2K for a local charity, Molly Olly Wishes by competing in a 120km cycle ride!
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