Don’t take full course of antibiotics, says BMJ

Don-t take full course of antibiotics, GPs told

According to an article in the BMJ doctors have been advised to stop telling patients to finish the full course of antibiotics as that is driving up antimicrobial resistance. “The antibiotic course has had its day,” argues Martin Llewelyn and colleagues. But Prof Dame Sally Davies, the Chief Medical Officer, said the public message should remain unchanged until there was further research.

Experts from bodies including Public Health England and Oxford University have turned the accepted wisdom on its head by advising that patients should be encouraged to continue taking medication only until they feel better. Current guidance from both the NHS and the World Health Organisation says that it is essential to “finish a course” of antibiotics to avoid triggering more virulent forms of disease.

In an article published by the British Medical Journal, 10 leading figures in the field said that the public health message was not backed by the evidence and that it should be dropped. They claim the existing advice 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 the 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 risk of resistance. We encourage policy-makers, educators and doctors to stop advocating to complete the course.”

The BMJ article argues 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 body’s resistance builds. Alison Holmes, professor of infectious diseases at Imperial College London, said it was “astonishing” that doctors still did 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.

However, the Royal College of GPs said it was “concerned” about allowing ­patients to judge for themselves when to stop taking medication. Its chairman, Prof Helen Stokes-Lampard, said changing the advice to patients would merely lead to confusion. “Recommended courses of antibiotics are not random – they are tailored to individual conditions, and in many cases courses are quite short,” she said. 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.”

Prof Dame Sally Davies, the Chief Medical Officer, said the public message should remain unchanged until there was further research. Guidance for managing infections was ­already being looked at by NICE.

For BMJ article see: http://www.bmj.com/content/358/bmj.j3418

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Jamie Woodward
FGDP(UK) response to 'The antibiotic course has ha
Nick Palmer, Editor of FGDP’s Antimicrobial Prescribing for General Dental Practitioners, says this BMJ piece reinforces the Faculty’s guidance for dentists:

"This will be nothing new for dentists. Our advice since publishing the first edition of our guidance in 2001, and in line with the BNF and scientific evidence, has always been that courses of antibiotics should not be unduly prolonged, because they encourage resistance and may lead to side-effects. Where antibiotics are indicated in the management of dental infections as an adjunct to definitive treatment such as drainage, the evidence is clear that complete resolution occurs within 3 days in most cases. We recommend that antibiotics should be prescribed where indicated for up to 5 days, with patients being reviewed at 2-3 days and discontinuing antibiotic use where there is resolution of temperature and swelling."
http://www.fgdp.org.uk/content/news/fgdpuk-response-to-the-antibiotic-course-has-had-i.ashx

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