Is it true that I have to finish my antibiotic treatment as prescribed?

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It is always the same. If I think that I had a reasonable idea and put it on-line, it will only take a day or two, until friends and colleagues let me know, that others had the same idea – just earlier. In this case, John Ferguson (@mdjkf), brought to my attention, that Professor Lyn Gilbert started the same discussion in Australia (Link). As always, I am depressed for about 5 seconds and start to come up with a new, old idea.

Despite the discussion in Down-under, I have promised to post the results of my questionnaire. On Twitter, some were surprised how little evidence exists to support antibiotic prescribing dogmas (Eli Perencevich, @eliowa), whereas others like Christina Vandenbroucke-Grauls (@ChristinaGrauls) believe that we have plenty of evidence from lab experiments and theory to answer the question. Most importantly, “every bit of antibiotic leads to resistance”.

The results

The great thing about a short questionnaire – chances are that people actually complete it. Thanks to the 220 people, who did follow the link to the survey and answered “all” questions.

The shortest reported time to answer the 30-second-questionnaire was 22 seconds. 81% of the responders worked in healthcare and nearly all of them were between the age of 31 and 60, with 43% being 31-45 years of age and 41% between 46 and 60 years, respectively.

With colleagues from 28 countries answering, it truly became an international survey, with the top five countries being the Netherlands (50), UK (46), Germany (17) Australia (16), and Malaysia (15).

Only 5.5% of the responders never received antibiotics, 30% had antibiotics but not always finished them, and the rest (63.5%) always finished the course of antibiotics they received.

Finally, 74% believed that it is true that you have to finish the course of antibiotics (as prescribed)? By the way, no significant difference in answering this question between healthcare professionals and non-professionals.

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Obviously, me forcing you to say “yes or no” wasn’t fair and many would have liked more questions and, especially, more answers. In the end, I share Christina’s opinion of: “There are reasons to finish your course of antibiotics, but to prevent resistance is not one of them”.

Depending on the books/journals you read (and how recent they are) your choice for pneumonia may vary from 10, 7, 5, or possibly even 3 days. In the future (once we overcome our natural fear to prescribe antibiotics for less than 10 days for an even number of days) it might become 4 or 6 days. Thus, “as prescribed” includes a lot of variety, but at least, most physicians will be convinced that their chosen course is the correct one and consequently needs to be finished.

Finally, my (or Lyn Gilbert’s) question might just be inappropriate, as the reason to give antibiotics is not to prevent antibiotic resistance, but to fight the infections and cure the patient.

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4 thoughts on “Is it true that I have to finish my antibiotic treatment as prescribed?

  1. Hi Andreas, great post and fascinating result. I find this all rather confusing. I had it firmly in my head that you have to finish a course of antibiotics to reduces the chances of resistance developing – but it seems that this is not the case at all. This seems a shame, since this message is so firmly embedded in the public’s consciousness (as demonstrated neatly by your survey).

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    • The nice thing is that many “dogmas” in medicine may be far less dogmatic as we think and that even some of our strongest believes can be challenged. If by now it is proven that I can treat the same infection with the same bug for 5 days, while I used 7 or 10 days in the past, obviously, antibiotics were unnecessarily used and the course could have been ended earlier. Still, I still tell colleagues pr patients to finish their course of antibiotics, if I agree (or determined) the length of it.

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  2. My understanding (drilled into me by my father from a very young age) was that not completing a course of antibiotics would result in a relapse because you hadn’t killed all the “bugs” and because you had exposed the “bugs” to a sub-lethal dose of antibiotics you increased the risk that they wouldn’t work the next time they were prescribed..

    Nothing I have learned since would lead me to challenge that belief.

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