Standard Practice on Antibiotics Called into Question
A new article in the British Medical Journal suggests that finishing the full antibiotic course isn't always necessary—but don't ditch those last few doses of antibiotics yet.
Every time my kids are prescribed antibiotics, I'm always stunned by how long the recommended course runs. Ten days? Two weeks? But of course, doctors always remind us to finish all the medication if we want to get better.
Now new information is calling that long-held standard into question. In an opinion piece published in The BMJ, the authors, who are practicing physicians, write, "With little evidence that failing to complete a prescribed antibiotic course contributes to antibiotic resistance, it's time for policy makers, educators, and doctors to drop this message."
The piece included several other startling assertions that run contrary to what we've been told about antibiotics for, well, basically forever:
- Patients are put at unnecessary risk for antibiotic resistance when treatment is given for longer than necessary, not when it is stopped early.
- For common bacterial infections no evidence exists that stopping antibiotics early increases a patient's risk of resistant infection.
- Antibiotics are a precious and finite natural resource which should be conserved by tailoring treatment duration for individual patients.
The researchers admit that clinical trials are needed to "determine the most effective strategies for optimizing duration" of antibiotics.
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They also surmise that finishing the full course of medication has persisted as a message to patients because of its simplicity. Study authors write, "Nevertheless, there is evidence that, in many situations, stopping antibiotics sooner is a safe and effective way to reduce antibiotic overuse."
So what are we to do as parents in light of this new advice? According to pediatrician Carrie Brown, MD, from Arkansas Children's Hospital in Little Rock—nothing yet. "By nature of the fact that it is an opinion and not a study, it should not necessarily cause anyone to take dramatic action in how they treat children—as a parent or as a medical provider. Instead it should cause people to think and ask more questions - leading to scientific study to answer those questions."
In other words, it's probably best to follow the advice of your pediatrician until we know more.