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The Advice to 'Finish Your Antibiotics' May Be Wrong

by Angelica Lai

Photograph by Twenty20

With children being bouncing grenades of germs and microbes, chances are you or your kid has been prescribed antibiotics. So you finish the entire course of antibiotics, even though you're feeling better, because that's what you've been told to do by the U.S. Food and Drug Administration, the World Health Organization and your grandmother. After all, you don't want to risk a relapse or contribute to drug-resistant superbugs.

But what if this long-held medical advice actually does more harm than good?

In a recent opinion published in the British Medical Journal, health experts argue there isn't enough evidence to support the idea that antibiotic resistance is strengthened by people stopping pills early. Instead, "taking antibiotics for longer than necessary increases the risk of resistance."

Not "completing the course" can be deemed irresponsible by doctors and patients. The established reasoning goes: If you don't finish your prescription, weak bacteria may be killed off, but stronger ones that would have been killed are still left. These stronger microbes can then multiply and pass on genetic-based survival instructions to other strains that'll make the infection much harder to fight the next time.

But Dr. Martin Llewelyn, lead author of the article and a professor of infectious diseases at Brighton and Sussex Medical School in England, and his colleagues say that the advice has been known to be wrong for quite a while and is overly simplistic. They say it is important to tailor each prescription to each infection and person, instead of giving blanket prescriptions. Having everyone finish their antibiotics always, which can be longer than necessary, may actually increase antibiotic resistance worldwide.

Llewelyn notes that there's growing evidence that short courses of antibiotics works just as well to treat many infections, though there are some exceptions like ear infections in very young children or TB infections.

The group of experts hopes more studies will be done to see if alternative messages, like "stop once your feeling better," can reduce antibiotic overuse. They've also noticed that language from official bodies, like the Centers for Disease Control and Prevention have replaced "complete the course" with messaging to take antibiotics "exactly as prescribed."

But other health care professionals are worried that changing the messaging can be too extreme.

"We are concerned about the concept of patients stopping taking their medication midway through a course once they 'feel better,' because improvement in symptoms does not necessarily mean the infection has been completely eradicated," Professor Helen Stokes-Lampard, leader of the Royal College of General Practitioners, tells BBC. "It's 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."

We know! So many mixed messages!

But there are a few things everyone seems to agree on: Antibiotics aren't always the answer. (The CDC reported last year that 1 in 3 antibiotic prescriptions in the U.S. were unnecessary). But don't self-medicate or simply stop when you're feeling better. Talk to your doctors and follow their instructions about when to stop and how you're feeling.

"The ideal future scenario would be that the right length of treatment for a specific infection for patients is identified from clinical trials and the exact quantity prescribed and dispensed," says Kieran Hand, spokesman for the Royal Pharmaceutical Society.

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