Controversial new medical advice on antibiotics contradicts over 3 decades of research

by Abel Hampton July 30, 2017, 0:09
Controversial new medical advice on antibiotics contradicts over 3 decades of research

"The focus of this article is on patient behaviour but health professionals in hospitals must be reassured that if a diagnosis of infection is excluded based on the results of diagnostic tests, then it is also not necessary to finish the course of antibiotics and the prescription should be cancelled".

An analysis in the British Medical Journal by United Kingdom experts in infectious diseases, microbiology and health psychology, who are working to tackle antimicrobial resistance, recommends that, outside hospital, where repeated testing is not feasible, patients should be advised to stop antibiotic treatment as soon as they feel better.

That said, Baym says that replacing the general advice to finish a course with general advice to not finish a course is likewise based on insufficient evidence.

In their article, Prof Martin Llewelyn of the Brighton and Sussex Medical School, and colleagues, said a change of approach is now necessary.

The advice to stop antibiotics when a patient feels better is also "too vague and subjective", said Dr. Yonatan Grad, assistant professor of immunology and infectious diseases at the Harvard TH Chan School of Public Health and an attending physician at Brigham and Women's Hospital and Harvard Medical School. A new study finds that standard-duration treatments, some of which last as long as 10 days, result in better outcomes and - contrary to popular belief - do not increase a child's level of antibiotic resistance. Research should look into the best way to tell patients to stop taking antibiotics, the analysis says, "such as stop when you feel better". They assert that there is also no evidence strong enough to support numerous current guidelines, a situation that forces physicians to rely on assumptions or historical practice to decide antibiotic treatment.

Public Health England and the University of Oxford are now advising patients to discontinue antibiotic use as and when patients feel better rather than continuing to take the medication for the prescribed length of time.

The authors said more trials were needed to establish what advice should be given to patients about how long to take the drugs. The use of third- and fourth-generation cephalosporins for the treatment of infections caused by E. coli and other bacteria in humans is associated with resistance to these antibiotics in E. coli found in humans.

The researchers behind this review challenge these established ideas by suggesting that shortening the course of antibiotic treatment could be just as effective and that "finishing the course" could actually be making the problem of antibiotic resistance worse.

The idea that we have a moral duty to complete any course of antibiotics that the doctor prescribes is intuitively comforting.

To update policies we need further research to inform them. The public should be encouraged to recognise that antibiotics are a precious and finite natural resource that should be conserved'. The ones leftover are the tougher bacteria, which would have been killed if the treatment continued but now, in the absence of antibiotics, have room to multiply and pass their genetic-based resilience to their progeny.

Always prescribing a fixed number of days for a course of antibiotics can potentially overlook individual patient characteristics, such as the fact that some patients may respond differently to the antibiotics.

But Professor Helen Stokes-Lampard, chair of the RCGP, said that "we can not advocate widespread behaviour change on the results of just one study". The longer the course, the more the resistance builds.

If you treat for too short a time, you may end up enriching the environment for antibiotic resistant organisms, she said. "We would urge our patients not to change their behavior", she said, adding that changing the accepted "mantra" would "simply confuse people".


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