Check out this answer from Consensus:
Stopping an antibiotic course early can contribute to the development of antibiotic resistance by allowing bacteria to survive and adapt. This misuse of antibiotics, along with overuse, is a key factor in the spread of resistance, leading to significant health and economic impacts globally. Addressing this issue requires careful management of antibiotic use and the development of new therapeutic strategies.
Antibiotic resistance is a significant global public health threat, exacerbated by the misuse and overuse of antibiotics. One critical question is whether stopping an antibiotic course early contributes to the development of antibiotic resistance.
Key Insights
- General Threat of Antibiotic Resistance:
- Mechanisms and Spread of Resistance:
- Impact on Healthcare and Society:
- Resistant infections result in higher rates of adverse outcomes, including clinical failures and increased economic burdens on healthcare systems2.
Does stopping an antibiotic course early increase antibiotic resistance?
Alexander M Aiken has answered Unlikely
An expert from London School of Hygiene and Tropical Medicine in Infectious diseases, Epidemiology, Microbiology
I’m in agreement with the broad sentiments from Llewelyn et al in BMJ 2017. I think the major driver of antibiotic resistance is use of antibiotics, so I think reducing usage of antibiotics, such as by stopping courses of antbiotics early, is very unlikely to promote resistance and may reduce resistance pressure.
There are a few execeptions, particularly for infections where treatment courses are very long – in particular TB – where incomplete treatment does recognizably result in greater probability of resistance. Similar situation with HIV, though that is not antibiotics.
Does stopping an antibiotic course early increase antibiotic resistance?
Jon Iredell has answered Likely
An expert from University of Sydney in Medicine, Bacteriology
The short answer is – sometimes; it depends… The same is true of the answer to the question: does stopping an antibiotic course early decrease antibiotic resistance?
Bottom line – our failure to grasp the complexity of adaptive biology and responsibly manage it is the reason we are changing the climate, causing extinction events and driving antibiotic resistance.
Perhaps the overweening demand for simple answers to simple questions is the reason politicians and the public debate have failed so badly in such areas. Short-term appeals to our innate selfishness is killing us all slowly.
Developing confidence in complex public debate is our challenge.
Does stopping an antibiotic course early increase antibiotic resistance?
Martin J Llewelyn has answered Extremely Unlikely
An expert from Brighton and Sussex Medical School in Infectious diseases
For the vast majority of infections in modern medicine this is very unlikely. Even for classic professional pathogen infections like TB where resistance DOES emerge on treatment the answer to this problem is combination therapy not longer courses. This is why TB is always treated with three or more drugs.
The evolutionary selection pressure exerted by antibiotics on their target is tiny compared to that exerted on all the bacteria which populate our bodies and near environment. These ‘commensal’ bacteria are the main reservoir of resistance genes. Stopping antibiotic treatment too soon MAY increase recurrence rates for some infections but the risk that the recurrent infection would be resistant seems to be very small. Conversely we know the more antibiotics you take the greater the risk of antibiotic resistant infection in the future. So it makes sense to try and use short antibiotic courses whenever possible. Its likely some patients need longer than others with the same infection. So the answer is probably to try and tailor antibiotic treatment duration for individuals. At the moment we don’t have great evidence to say how to do this though.
Of note the WHO are revising their guidance – moving away from ‘complete the course to avoid resistance’ and saying ‘always follow your prescribers advice’. Similarly in the UK Public Health England are removing ‘complete the course to avoid resistance’ from their messaging. This is long overdue. “experts” in this field have been pointing out ‘complete the course to avoid resistance’ is wrong for a long time. See this article from 1999 Don’t keep taking the tablets? – The Lancethttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01139-3/abstract
Does stopping an antibiotic course early increase antibiotic resistance?
Proia Lorenzo has answered Likely
An expert from Université Libre de Bruxelles in Environmental Science, Microbiology
I guess that is not really possible to answer this question on antibiotics in general. From my point of view too many factors co-act and may vary the responses of resistant bacteria to antibiotics therapy.
Does stopping an antibiotic course early increase antibiotic resistance?
Joao Goncalves-Pereira has answered Extremely Unlikely
An expert from Hospital Vila Franca de Xira in Infectious diseases, Internal Medicine
There are extensive data relating the longer duration of antibiotic therapy both in vitro and in vivo (see, for instance, Thomas. Antimicrob Agents Chemother.1998;42:521; Singh. Am J Resp Crit Care Med.2000;162:505). On opposite, studies addressing reduction of the duration of antibiotic therapy almost always showed the decreased in infections caused by multi resistant organisms (see Chastre JAMA.2003;290:2588 or Micek Chest 2004;125:1791). In fact bacteria may gain resistance my mutations or derepression of genetic locus associated with resistance. Both these mechanisms are associated with longer antibiotic exposures.
Does stopping an antibiotic course early increase antibiotic resistance?
Divya Ramnath has answered Extremely Unlikely
An expert from University of Queensland in Molecular Biology, Hepatology, Infectious diseases
No, using excessive antibiotics are major cause of antibiotics-resistance. Therefore, stopping a course of antibiotics is very unlikely to cause this.
Does stopping an antibiotic course early increase antibiotic resistance?
Amanda E Brooks has answered Likely
An expert from North Dakota State University in Pharmaceutics, Biological Materials
I think it depends on the location and nature of the infection, but in many cases I think the evidence is pretty good that it does. For example, if you take an antibiotic and start feeling better so you stop the antibiotic, there maybe some lingering bacteria, which we like to call persisters. Persisters are prevalent under physiological conditions that favor metabolic senescence. Furthermore, persisters acquire antibiotic resistance at a high rate, allowing them to subsequently spread resistance to other bacteria. Bacteria that have acquired resistance can also display an increase in virulence.
Nevertheless, these data do not necessarily indicate that we need to use extremely long course of antibiotics as many of our antibiotics are extremely good at quickly killing their bacterial targets. Instead the data are a better indication that 1) the community needs to understand the appropriate dosing and length of time necessary to eradicate an infection, and 2) patients need to complete the course of medication as prescribed.
Does stopping an antibiotic course early increase antibiotic resistance?
A Bashir has answered Extremely Unlikely
An expert from Aston University in Microbiology
https://www.google.co.uk/amp/s/inews.co.uk/opinion/yes-really-take-full-course-antibiotics/amp/
I wrote this this article in response to the BMJ publication explaining my point of view.
Does stopping an antibiotic course early increase antibiotic resistance?
Smitha Sukumar has answered Unlikely
An expert from University of Sydney in Dentistry, Microbiology
When you are prescribed an antibiotic, the duration of the prescription is determined by the shortest possible time needed to completely kill all the bacteria causing the infection.
You will often feel better a couple of days after starting the prescription. But, an improvement in symptoms, does not always mean that the infection has completely gone. The established view is, if you stop taking the antibiotics early the bacteria that survive are the “strongest” (able to resist the antibiotics) and these bacteria contribute to antibiotic resistance.
Antibiotic resistance is one of the major threats to modern medicine and to our way of life. The resistance crisis is due largely to over and inappropriate use of antibiotics in health care and agriculture. The focus of international organisations, national governments and health experts is to reduce the use of antibiotics to combat the growing problem of resistance.
Evidence is emerging that shorter courses of antibiotics lasting three to five days, work just as well to treat many bugs. Shorter treatments make more sense – they are more likely to be completed properly, have fewer side effects and should be cheaper. They also reduce the exposure of bacteria to antibiotics, thereby reducing the speed by which pathogens develop resistance. Therefore, according to experts like Professor of Infectious Diseases, Martin Llewelyn it is time to reconsider the advice that people should always complete an entire course of antibiotics. It means using fewer antibiotics.
However, this advice comes with a caveat. There is currently not enough evidence to back the idea that stopping pills early encourages antibiotic resistance, indeed, there is a case to suggest that using antibiotics for longer than necessary can increase the risk of resistance. To determine if shorter courses reduce resistance, future studies would have to consider wider health outcomes, including relapse of infection and illness. It would be difficult to mount this type of clinical study.
In the meantime, “finish the course!”. Antibiotic prescriptions are tailored to each infection and each person. Prescriptions today are likely to be shorter and only given when necessary.
Does stopping an antibiotic course early increase antibiotic resistance?
Karen Angeliki Krogfelt has answered Uncertain
An expert from Roskilde University in Microbiology, Microbiome, Infectious diseases
It depends on the bacterium in question and on teh antibiotc type used . In some case sublethal concentrations of the antibiotic will promote the development of antibiotic resistace . Yet, it is advised in general to restrict eh antibiotic use.
Does stopping an antibiotic course early increase antibiotic resistance?
D G Joakim Larsson has answered Extremely Unlikely
An expert from University of Gothenburg in Microbiology
Stopping antibiotic treatment too early is of course not good from the perspective that the infection might not have been completely treated yet and you could get worse again. It is a different thing if stopping early would increase risks for driving resistance. The latter is very unlikely. Resistance is promoted because niches are made available for the resistance ones when sensitive bacteria are killed off. The earlier one stops with antibiotic treatment, the fewer opportunities for the resistance ones to propagate. Recall that the doctor often treat with a rather broad antibiotic right away in case the infection is severe and the resistance profile unknown. Then, if/when the resistance profile of the causative agent is figured out (through culturing), the doctor switches to an antibiotic with narrower spectrum. This strategy decreases risks for resistance promotion. Notice that this is basically equivalent to stopping antibiotic treatment for those groups of bacteria that were targeted by the first broad-spectrum antibiotic that, after the switch to an antibiotic with narrower spectrum, will no longer be affected.
Does stopping an antibiotic course early increase antibiotic resistance?
Mohamed E El Zowalaty has answered Likely
An expert from University of KwaZulu-Natal in Microbiology, Virology, Immunology
Stopping a course of Antibiotics may promote resistance in some cases. This was proven experimentally and most like same in vivo ( including in human).
My experience and opinion is that discontinue a course of Antibiotics earlier may induce resistance in some cases but not always. The dynamics of antibiotics inside human body and during treatment courses is a multifactorial process.
Antimicrobial Resistance (AMR) acts on the immune system of the bacteria to protect it from the harmful and toxic antibiotics, meaning bacteria develop resistance as an immunity.
AMR is a complex multifactorial process. In vivo during therapy dynamics of antibiotics play a major role as well.
So stopping a course earlier require further investigation to rule out its definitive role, not much in vivo research is available on this point.
Also I have seen several patients once their condition is improved they stop antibiotics use and course.
I do believe that antibiotics course should be minimal period and based in isolation of the causative bacteria and determining its sensitivity profiles, which may be inapplicable or costing especially in outpatients.
Physicians used empirical therapy in treatment based on their clinical investigations and not always involve the Microbiology lab part to define the causative bacteria and define the sensitivity profiles.
Another important is to monitor patients on antibiotics for improvement otherwise to change antibiotics or determine what is going on as resistance may be ongoing while a course of treatment is given.
Does stopping an antibiotic course early increase antibiotic resistance?
Mervyn Singer has answered Extremely Unlikely
An expert from University College London in Infectious diseases
Short courses – one dose – are now recommended for urinary tract infections and other infections and there does not seem to be either a flare-up of the same infection or resistance in patients treated so.
Second, countries who traditionally use short courses of therapy (4-5 days) – such as the UK, Netherlands, and the Scandinavian countries – have overall much lower rates of resistance compared to longer duration users (USA, Greece, Spain, Italy…)