MS Speaks

For decades we've had it dinned into us that an antibiotic must be taken exactly as prescribed. If the rx says to take it for 10 days, you must take it for 10 days, without skipping a dose, and without giving up on it after fewer than 10 days because you start feeling better. We were told that the bugs the antibiotic was targeting would bounce back if we stopped taking the antibiotic early.

Now they're saying that in many cases that is the wrong advice. The exception is otitis media.

From NEJM Journal Watch, July 27, 2017:

Advice to "Complete the Course" of Most Antibiotics Seen as Unfounded

By Joe Elia

Edited by Susan Sadoughi, MD

The "deeply embedded" view that failing to complete a course of antibiotics will lead to drug resistance has no evidentiary basis, according to an analysis in The BMJ.

The authors cite exhortations from the World Health Organization (and similar advice from the CDC) to "always complete the full prescription" as unfounded, and observe that studies on the best duration of most antibiotic therapies simply haven't been done. They write: "Patients might be best advised to stop treatment when they feel better."

To support their argument, the authors cite trials — for example, in streptococcal pharyngitis and community-acquired pneumonia — in which shortened courses were noninferior to longer, standard treatments. (However, they also cite the need to complete full-course therapy in otitis media, where research has shown the advantage of doing so.)

The public should understand, they say, that resistance results from overuse "and is not prevented by completing a course."

The article is available here.