In a recent BMJ article, Llewelyn et al. argue that the old dogma of completing a prescribed course of antibiotics to prevent antibiotic-resistance is a myth, not based on evidence. Actually the opposite, namely taking antibiotics for longer than necessary, increases the risk of resistance.
While I love breaking down old dogmas (we actually had a poll on this topic some time back), many of today’s papers in the Netherlands (and I am pretty sure elsewhere, too) misinterpret the study, by slaughtering the message to patients to “always complete the full prescription”. One of the Netherlands most influential newspapers the Volkskrant, already wrote: “Finishing antibiotic course? Nonsense.”
What people seem to overlook is the fact that not the message to complete the full prescription is wrong, but the reasoning that was given (development of antibiotic resistance). Clearly, policy makers and doctors, need to keep in mind that a shorter course of antibiotics can be as effective as the long course from the past, but the main reason to give antibiotics is not to prevent development of resistance but to offer our patients the most effective treatment and for many of those treatments patients need to finish the full course of antibiotics to avoid relapse or other complications.
The message of “antibiotic resistance” seems to overwrite all the good reasons while we started antibiotic stewardship, namely to offer patients the most effective antibiotic, in the correct dosage, the needed application form, for a proven length of course, with as little side-effects and interaction with other medications as possible. In doing we may prevent resistance development, but our primary goal was and should stay to offer the best treatment to our patients.
The message “Finishing antibiotic course? Nonsense” is cutting a lot of curves and unfortunately will lead to “throwing out the baby with the bathwater”.
Llewelyn et al. The antibiotic course has had its day. BMJ 2017;358:j3418 doi: 10.1136/bmj.j3418 (Published 2017 July 26) ,
Ellen de Visser, De Vokskrant, Thursday 27 July 2017