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Completing Antibiotic Courses Less Necessary Than Previously Thought?

If you’ve ever had a condition that required antibiotics, chances are you’ve been told by your medical professional to complete the entire course of them, regardless of when the condition actually clears up. Typically, this classic gem of advice is given to make sure any illness is completely resolved. However, new research suggests that maybe it is unnecessary for patients to follow antibiotics courses through to completion; instead, a patient should stop taking the antibiotics once they feel better, regardless of how much of the prescription remains.

The advice to complete antibiotics courses stems from the concern that if they are left uncompleted, the bacteria that might ordinarily be killed by the antibiotics will survive in part, and then evolve to become resistant to the antibiotics. This leads to conditions that are harder to treat because fewer cures affect the bacteria. However, there is new information that runs counter to this long-standing belief.

According to Martin Llewelyn, who is a professor specializing in infectious diseases at Brighton and Sussex medical school, the opposite is actually true. Documented in their analysis in the British Medical Journal, the claim that antibiotic resistance grows not as a result of stopping the treatments early; there is no evidence to support it. Instead, taking antibiotics for longer than they are needed is what leads to an increased resistance among harmful bacteria.

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Notable exceptions to this hypothesis include serious illnesses like tuberculosis, which may grow more aggressive and drug-resistant if not properly and fully treated. However, when it comes to sickness, people tend to get ill when harmful bacteria manage to enter the bloodstream; as it stands, our skin, particularly our hands, is covered in bacteria such as E. coli, that causes no harm because it is on the outside. Exposing this currently harmless bacteria to antibiotics unnecessarily can lead to a situation of increased resistance, which then becomes a problem if the bacteria moves from the skin into the body.

Part of the problem with this disagreement over antibiotic courses is the variable nature of them. How much of a given medicine, how often it should be taken, and how long it should be taken for are things that may all vary based on the person who is to be treated. Their medical history may also affect dosage. Ultimately, this limits the knowledge base into an ideal antibiotic course.

This particular problem generally affects those who take their prescriptions at home, they note. In the hospital, it is easy to monitor patients and more quickly finetune the medication;  however, it is much more difficult to keep track of patients at home, decreasing the ability of medical professionals to monitor and adjust dosages. As a general rule then, they suggest that such patients refrain from taking their treatments once they feel better. This advice runs counter to the World Health Organization’s (WHO) opinion on the matter.

This review, in fact, is not the first of its kind. According to Imperial College London’s infectious diseases professor Alison Holmes, there was an article featuring the same point published in 1999. This report was prepared by Professor Harold Lambert, a British authority.

Additional experts have supported the conclusions of the group. Among them, Peter Openshaw, who is the president of the British Society for Immunology. Ultimately, he asserts that the review’s findings clarify the benefits (or lack thereof) regarding longer antibiotics courses. Ultimately, he believes a shorter course of antibiotics can lead to less resistance on the part of the bacteria, rather than more resistance.

According to St. George’s University microbial pathogenesis professor Jodi Lindsay, this fast and flawed information regarding lengthy courses of antibiotics stems from a concern of undertreating diseases. She stresses that there is a need for more research, both to compare shorter courses to longer ones, and to identify additional outlier illnesses.

Ultimately, supporters of these findings like Holmes, Openshaw, and Lindsay are surprised and dismayed to see such a limited understanding of antibiotics courses appropriate to the illnesses in need of curing. Beyond specific, well-researched exceptions, the majority of such information is uncharted territory.

 

BacteriaWhile there is some measure of support for the findings of Llewelyn and his group, the theories are not without a level of opposition as well. For example, the Royal College of GPs  clarified that the length of a given antibiotics course is not chosen at random. According to GP’s Professor Helen Stokes-Lampard, it is a decision based off of the individual to be treated, as has been mentioned earlier. Furthermore, Lampard asserts that many courses of antibiotics are short rather than lengthy- matters of days. Specifically, Lampard is concerned for the patients who would stop their medication halfway through.

The concern comes from the fact that feeling better is no guarantee of a completely cured infection. Symptoms may begin to fade well before the infection has been dealt with, which when combined with this advice, might lead to patients stopping their medication before their infections resolved, leading to potentially worsening illness. Keeping the advice the same allows patients to avoid becoming confused.

Regardless of one’s stance on this specific issue of antibiotic courses, one point remains true: it is imperative that more research is done on them so that we can improve medical practices. This is particularly important if we are to expect people to follow the advice given to them by doctors and other healthcare professionals. For this undertaking, The National Institute for Health and Care Excellence is delving into research on many common infections and how to manage them best. Ideally, this understanding will help better frame the courses of antibiotics to the illness.

Other organizations such as the Department of Health will review prescription information and infections that are resistant to drugs, which will also help to determine the best treatment duration and methods for a given illness.

So, what should you do if you have a course of antibiotics, but you are feeling better before you’ve finished? It really seems to depend on the illness at hand and its severity; While the camps are pretty split, you may opt to talk to your medical professional about whether or not you should stop early or complete the course. Your doctor will likely advise that you finish the course just in case, but another inspection once you are feeling better may help determine if the illness is still present.