Sarah Knapton, SCIENCE EDITOR – THE TELEGRAPH
27 July 2017 • 11:26am
Doctors must stop telling patients to finish an entire course of antibiotics because it is driving antimicrobial resistance, a group of eminent specialists has warned.
Patients should be encouraged to continue taking medication only until they feel better, to avoid the overuse of drugs, experts from bodies including Public Health England and the University of Oxford are now advising.
Current guidance from the NHS and the World Health Organisation says it is essential to ‘finish a course’ of antibiotics to avoid triggering more virulent forms of disease.
But in a new article in the British Medical Journal (BMJ), 10 leading experts said the public health message is not backed by evidence and should be dropped. They claim it actually puts the public at greater risk from antimicrobial resistance.
“Historically, antibiotic courses were driven by fear of under treatment, with less concern about overuse,” said lead author Martin Llewelyn professor of infectious diseases at Brighton and Sussex Medical School.
“The 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 resistance.
“We encourage policy makers, educators, and doctors to stop advocating ‘complete the course’ when communicating with the public.”
Fears that stopping antibiotics early could trigger more dangerous forms of disease date back to Alexander Fleming who found that bacteria quickly become ‘acclimatised’ to penicillin and patients who take insufficient doses may transmit a more dangerous strain to family members.
In his Nobel Prize acceptance speech in 1945, Fleming warned: “If you use penicillin, use enough.”
But in the BMJ article the experts argue that when a patient takes any antibiotics it allows dangerous strains of bacteria to grow on the skin and gut which could cause problems later. The longer the course, the more the resistance builds.
In the UK, at least 12,000 people die from antibiotic-resistant bugs each year, experts estimate – more than die of breast cancer.
The specialists also warn that current guidance ignores the fact that patients often respond differently to the same antibiotic, with some needing longer courses than others.
However the Royal College of GPs said it was ‘concerned’ about allowing patients to judge for themselves when to stop taking medication, and argue it could cause confusion.
Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: “Recommended courses of antibiotics are not random – they are tailored to individual conditions, and in many cases courses are quite short, for example for urinary tract infections, three days is often enough to cure the infection.
“We are concerned about the concept of patients stopping taking their medication mid-way through a course once they ‘feel better’, because improvement in symptoms does not necessarily mean the infection has been completely eradicated.
“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.”
Chief medical officer Dame Sally Davies, also said that the message to the public should remain unchanged until there was further research.
“NICE is currently developing guidance for managing common infections, which will look at all available evidence on appropriate prescribing of antibiotics,” she said.
“The 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.”
Yet many independent experts argued that changes to prescribing rules were long overdue.
Commenting on the research Alison Holmes, Professor of Infectious Diseases at Imperial College London said it was ‘astonishing’ that doctors still do not know the optimum duration for taking drugs even though a long course raises the risk of bacterial resistance.
“The ‘complete the course’ message directly conflicts with the societal messages regarding the changes needed in behaviour and attitudes to minimise unnecessary exposure to antibiotics,” she said.