Is it a Myth That You Should Finish Your Course of Antibiotics?

Researchers have recently claimed that the importance of finishing a course of antibiotics is an ‘urban myth’, with not enough evidence to support it – going against what patients have long been told by their doctors. What is the evidence around how long to take antibiotics for, and why are there concerns about overuse of antibiotics?  

Long-held belief

If a doctor prescribes a course of antibiotics, we’re used to being told that you should always finish all the tablets, even if you feel better before then. The reason behind this is widely regarded to be that there is a risk of the infection returning if the antibiotics are stopped early.

Now this long-held belief is being questioned

A group of researchers have suggested that not only is it not necessary to finish a course of antibiotics, but that finishing the course could actually be increasing antibiotic resistance – the growing problem of bacterial strains becoming resistant to antibiotics and therefore ineffective.

Lack of evidence

The researchers have published a review, which was published in the British Medical Journal, arguing that the advice to always finish a course of antibiotics is not backed up by evidence.

They claim that overuse of antibiotics is actually more problematic than the potential risk of the infection returning: “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 advice about finishing a course is thought to go all the way back to when antibiotics were first used, during the 1940s. Of course at that time there wasn’t the present day concerns about overuse of antibiotics and resulting antibiotic resistance.

Stop when you feel better?

The review also highlights the fact that different people respond differently to antibiotics, and that the recommendations for the length of time to take antibiotics for do not take that into account, and is in fact often an arbitrary timeframe.

They suggest that a simpler message should be: ‘stop when you feel better’. The British Society of Antimicrobial Chemotherapy is sceptical of this simplistic message, however. They have said that ‘when you feel better’ is too subjective and risks treatment failure or relapse as people won’t know when the cause of their infection has been eradicated.

They have called for urgent research to identify all those infections that do not need to be treated with antibiotics, and to identify the most effective length of treatment for those infections that do. They added: “We also need a robust assessment of the harm that stopping antibiotics early might cause in higher-risk or vulnerable patients. Doctors and patients should always discuss the pros and cons of antibiotics and, if prescribed, what course length is appropriate.”

NHS and Public Health England advice is still to take antibiotics for as long as your doctor tells you to. This is just one study, they warn, and not the basis for a change in prescribing policy.

Drug-resistant infections

There is certainly ever-growing concern about the amount of antibiotics being prescribed, and that there will come a time in the future when none of them will be effective.

The World Health Organization estimates that 700,000 people around the world die each year from drug-resistant infections.

There is a fear that time is running out; that we are losing the battle to stay ahead of resistance of bacterial infections to antibiotics.

It was a decade ago that the superbug MRSA made the headlines with hospital patients getting staphylococcus aureus infections that were resistant to the antibiotic methicillin.

Scares such as these will continue, as scientists struggle to find new antibiotics, which is a difficult and time-consuming process. Any new antibiotics often have their use restricted, in an attempt to preserve their ability to fight infection.

Reduce antibiotic usage

Reducing our use of antibiotics, on a global scale, is thought to be the only way to slow down antibiotic resistance.

That said, a new class of antibiotics has very recently been found to work against the sexually transmitted infection gonorrhoea, which is becoming resistant to existing antibiotics – giving hope that scientists could be finding ways of fighting back against antibiotic resistance.

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