- A new report is challenging conventional wisdom about how we use antibiotics. The message has always been to finish your entire course of antibiotics, but what if those prescriptions are too long to begin with? Allison Vuchnich reports.
Doctors always tell you: finish your antibiotics. But now British scientists suggest that the prescription length may be too long in the first place.
It’s a controversial stance coming from a team of U.K. scientists – they say that for eons, doctors told patients to complete their course of antibiotics to prevent the growth of drug-resistant bacteria, without any evidence propping up this worry.
They’re calling the age-old advice a “myth.”
“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 team, led by Dr. Martin Llewelyn, wrote in a paper published in the BMJ.
“We encourage policymakers, educators and doctors to stop advocating ‘complete the course’ when communicating with the public,” they said.
So what should patients with prescribed antibiotics do instead?
“Outside hospital, where repeated testing may not be feasible, patients might be best advised to stop treatment when they feel better,” the scientists say.
Or ask your doctor if a shorter course of antibiotics will be enough, and if you are feeling better go for a follow-up appointment to see if you can stop taking the medication.
“If your doctor prescribes you something it’s absolutely okay to say are you sure I need this long? Can I have a shorter course? Or to say if I am getting better on the fifth day, can I stop taking them?” Dr. Allison McGeer, medical director of infection control at Mount Sinai Hospital, said.
“We have been so focused on making sure people get enough antibiotics that we haven’t spent a lot of time in the last 50 years figuring out what the minimum amount of antibiotics is,” McGeer said.
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One of the study authors, professor Tim Peto, told Global News they are not implying that patients should stop taking their antibiotics, “we never intended that, we were talking to doctors, to say they can use their clinical judgement and reduce the length of treatment without resistance emerging. We never intended patients take it into their own hands. He added that patients should “follow your doctors advice.”
The paper is an opinion piece. The authors, out of Brighton and Sussex Medical School, warn that long prescriptions for antibiotics are based on outdated ideas.
WATCH: Paper author Tim Peto on why British docs are suggesting length of antibiotics prescriptions should be shortened
Traditionally, doctors thought that if you stop your course of antibiotics, too few tablets could cause germs to mutate and grow resistance to the medication.
With recent research, scientists believe that shorter prescriptions – about three to five days – are enough to fight most bugs. If you take drugs for longer than needed, you may be arming germs with more resistance.
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There are some exceptions, though: tuberculosis is the prime example – it’s a bug that grows resistant if drugs aren’t taken for an adequate amount of time, they note. HIV is another they highlight as an anomaly.
Critics don’t agree with their stance, though. Just because symptoms are waning, it doesn’t mean the infection has cleared, according to Dr. Helen Stokes-Lampard, leader of the Royal College of General Practitioners, in the U.K.
“We are concerned about the concept of patients stopping taking their medication mid-way through a course once they ‘feel better’ because improvement in symptoms does not necessarily mean the infection has been completely eradicated,” she told the BBC.
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Response from the U.K. about the British editorial has been a mixed bag. England’s chief medical officer, Dr. Sally Davies, for example, urged patients to stay the course with the prescribed antibiotics.
“The message to the public remains the same: people should always follow the advice of health-care professionals. To update policies, we need further research to inform them,” she told the Guardian.
Antibiotic resistance and so-called “superbugs” are a major concern for global health officials.
In February, the World Health Organization warned that the world is on the cusp of a “post-antibiotic” era with dozens of bacteria – not just sexually transmitted bugs – growing resistant to all medications we have on hand.
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In his final days as Canada’s chief public health officer, Dr. Gregory Taylor told Global News in 2016 that superbugs were of utmost concern to him.
We’re nearing a reality in which operations can’t happen or routine infections could kill people, he warned.
“This is public enemy No. 1,” Dr. Gerry Wright, lead researcher and McMaster University scientist, said of superbugs.
Almost 90 years ago, Scottish researcher Alexander Fleming discovered penicillin and ushered in a wave of new medications, all derived from bacteria in the soil beneath our feet.
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Suddenly, pneumonia, tuberculosis, blood infections — ailments that once killed entire communities at a time — became manageable. Antibiotics were dubbed “wonder drugs”: they revolutionized medical care and extended life expectancy.
But we’re still relying on old innovations: half of the antibiotics prescribed to sick patients today were discovered in the 1950s, Canadian research suggests.
Wright says there have been virtually no new antibiotics discovered since the 1980s.
“We’re at a very precarious point simply because we don’t have any new drugs coming on board,” Wright told Global News.
Read the full BMJ paper.
carmen.chai@globalnews.ca
Follow @Carmen_Chai
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