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why do you have to finish antibiotics

Telling patients to stop taking antibiotics when they feel better may be preferable to instructing them to finish the course, according to a group of experts who argue that the rule long embedded in the minds of doctors and the public is wrong and should be overturned. Patients have traditionally been told that they must complete courses of antibiotics, the theory being that taking too few tablets will allow the bacteria causing their disease to mutate and become resistant to the drug. But Martin Llewelyn, a professor in infectious diseases at Brighton and Sussex medical school, and colleagues claim that this is not the case. In, the experts say Бthe 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 resistanceБ. There are some diseases where the bug can become resistant if the drugs are not taken for long enough. The most obvious example is tuberculosis, they say. But most of the bacteria that cause people to become ill are found on everybodyБs hands in the community, causing no harm, such as
and Staphylococcus aureus. People fall ill only when the bug gets into the bloodstream or the gut. The longer such bacteria are exposed to antibiotics, the more likely it is that resistance will develop. The experts say there has been too little research into the ideal length of a course of antibiotics, which also varies from one individual to the next, depending in part on what antibiotics they have taken in the past.


In hospital, patients can be tested to work out when to stop the drugs. БOutside hospital, where repeated testing may not be feasible, patients might be best advised to stop treatment when they feel better,Б they say. That, they add, is in direct contravention of World Organisation advice. Other experts in infectious diseases backed the group. БI have always thought it to be illogical to say that stopping antibiotic treatment early promotes the emergence of drug-resistant organisms,Б said Peter Openshaw, president of the British Society for Immunology. БThis brief but authoritative review supports the idea that antibiotics may be used more sparingly, pointing out that the evidence for a long duration of therapy is, at best, tenuous. Far from being irresponsible, shortening the duration of a course of antibiotics might make antibiotic resistance less likely. Б Alison Holmes, a professor of infectious diseases at Imperial College London, said a great British authority, Prof Harold Lambert, had made the same point in as early as 1999. БIt remains astonishing that apart from some specific infections and conditions, we still do not know more about the optimum duration of courses or indeed doses in many conditions, yet this dogma has been pervasive and persistent. Б Jodi Lindsay, a professor of microbial pathogenesis at St GeorgeБs, University of London, said it was sensible advice. БThe evidence for Бcompleting the courseБ is poor, and the length of the course of antibiotics has been estimated based on a fear of under-treating rather than any studies,Б she said.


БThe evidence for shorter courses of antibiotics being equal to longer courses, in terms of cure or outcome, is generally good, although more studies would help and there are a few exceptions when longer courses are better Б for example, TB. Б But the Royal College of GPs expressed concerns. БRecommended courses of antibiotics are not random,Б said its chair, Prof Helen Stokes-Lampard. БThey are tailored to individual conditions and in many cases, courses are quite short Б for urinary tract infections, for example, three days is often enough to cure the infection. БWe are concerned about the concept of patients stopping taking their medication midway through a course once they Бfeel betterБ, because improvement in symptoms does not necessarily mean the infection has been completely eradicated. ItБs important that patients have clear messages and the mantra to always take the full course of antibiotics is well known. Changing this will simply confuse people. Б EnglandБs chief medical officer, Prof Dame Sally Davies, said: БThe message to the public remains the same: people should always follow the advice of healthcare professionals. To update policies, we need further research to inform them. Б[The National Institute for Health and Care Excellence] is currently developing guidance for managing common infections, which will look at all available evidence on appropriate prescribing of antibiotics. БThe Department of Health will continue to review the evidence on prescribing and drug-resistant infections, as we aim to continue the great progress we have made at home and abroad on this issue.


Б Does stopping a course of antibiotics early lead to antibiotic resistance? Q: Does stopping a course of antibiotics early lead to antibiotic resistance? A: There has been a lot of research into how long antibiotic courses should be, to determine the shortest possible length of course needed to completely kill all bacteria. If you are being treated for an infection, the kind of antibiotics your doctor prescribes and the length of the course should be based on the best evidence. Feeling better, or an improvement in symptoms, does not always mean that the infection has completely gone. Your doctor has had years of training and has access to the latest evidence so always follow their advice. Evidence is emerging that shorter courses of antibiotics may be just as effective as longer courses for some infections. Shorter treatments make more sense they are more likely to be completed properly, have fewer side effects and also likely to be cheaper. They also reduce the exposure of bacteria to antibiotics, thereby reducing the speed by which the pathogen develops resistance. WHO publishes guidelines about treatments for different infections and recommends treatment durations and doses of antibiotics based on the best clinical evidence for each case. We continuously review the latest research so that we can provide updated recommendations to health professionals.

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