Check out this answer from Consensus:
The evidence suggests that for many uncomplicated infections, shorter courses of antibiotics may be just as effective as longer ones, and stopping antibiotics early could help reduce unnecessary exposure and combat AMR. However, any change in guidelines should be approached with caution, ensuring that both clinicians and patients are well-informed and supported by robust evidence. Further research is needed to establish clear, evidence-based recommendations for antibiotic duration tailored to individual patient needs.
The long-standing medical advice to “finish the course of antibiotics” has been a cornerstone of antibiotic prescribing practices for decades. However, recent research and expert opinions are challenging this dogma, suggesting that it may not be necessary and could even contribute to the growing problem of antimicrobial resistance (AMR). This article explores the evidence and arguments for and against the traditional advice, examining whether it is time for a change in how antibiotics are prescribed and used.
Historical Context and Current Practice
The advice to complete the full course of antibiotics has its roots in early antibiotic use and the fear of developing resistance. Alexander Fleming, in his Nobel Prize acceptance speech in 1945, warned about the dangers of antimicrobial resistance, a concern that has only grown over the decades1. The traditional belief is that stopping antibiotics early could lead to the survival of partially resistant bacteria, which could then multiply and spread.
Challenging the Dogma
Recent studies have begun to question the necessity of completing a full course of antibiotics for many common infections. For instance, clinical trials have shown that shorter courses of antibiotics can be just as effective as longer ones for conditions like community-acquired pneumonia, pyelonephritis, and cellulitis1. These findings suggest that the duration of antibiotic therapy should be tailored to the patient’s clinical response rather than adhering to a fixed duration.
Evidence from Clinical Trials
The STOP-AB trial in Spain investigated the impact of discontinuing antibiotics when physicians deemed them no longer necessary. The study found no significant difference in the duration of severe symptoms between patients who stopped antibiotics early and those who completed the course, suggesting that early discontinuation could be safe and effective for uncomplicated acute respiratory tract infections2.
Perspectives from Clinicians and Patients
A qualitative study in England explored the views of clinicians and patients on stopping antibiotics when feeling better (SAWB). While clinicians were open to the idea if supported by evidence, patients were more hesitant due to concerns about recurrence and complications3. This highlights the need for clear communication and evidence-based guidelines to support any changes in practice.
Risks and Considerations
Despite the emerging evidence, some experts caution against a blanket change in advice. Concerns include the potential for patients to misinterpret “stop when you feel better” and the risk of incomplete treatment leading to relapse or complications4. Additionally, changing long-standing guidelines could undermine trust in medical advice and lead to confusion among patients5.
Antibiotic Deprescribing
The concept of antibiotic deprescribing, where doctors recommend stopping antibiotics if further treatment may cause more harm than benefit, is gaining traction. A survey of Spanish general practitioners found that most had used this strategy, particularly for conditions like the common cold and influenza, though there was less confidence in its use for acute bronchitis6.
Should doctors stop telling patients to “finish the course of antibiotics”?
Divya Ramnath has answered Unlikely
An expert from University of Queensland in Molecular Biology, Hepatology, Infectious diseases
Doctors shouldn’t prescribe antibiotics unnecessarily – to prevent the evolution of antibiotic-resistant bacteria (or Superbugs). However, if the antibiotics are needed, they should recommend completion of the course to ensure that the infection is cleared completely.