A latest controversial study published by researchers from Brighton and Sussex Medical School in the UK questioned the idea that patients must consume antibiotics as prescribed by their physicians and asked policy makers to drop the recommendation because it is unnecessary.
The researchers also argued that, contrary to popular belief, the "complete course" recommendation is outdated, not evidence-based, and could even cause an increased risk in antibiotic resistance, but doctors have now fired back and accused the researchers of advocating irresponsible advice that could risk a patient's health.
Both sides have presented their justifications for their position but who is really advocating correct medical advice between the two?
On one side, Martin Llewelyn and his colleagues argued that doctors should consider the fact that short antibiotic treatments can be as effective as — or maybe even more effective than — longer treatments. On the other side, doctors who have been giving prescriptions throughout their careers argue against stopping a prescription prematurely since a decrease in symptoms doesn't always mean the source has been eliminated.
Both actually have valid points to consider but patients should keep in mind that any medical advice should be evaluated on a case-by-case basis.
To finish or not to finish (prescribed antibiotics), that is the question.
Antibiotics Intake Should Depend On The Patient
According to Llewelyn, et al., the idea that "stopping antibiotics early leads to antibiotic resistance" is not from validated scientific studies. They further claim that the fear of undertreating patients is what drives doctors to recommend longer treatments, and that studies to determine the minimum length of time for treatments have not been performed. Since people continue to take medication past what could be the optimal minimum treatment, diseases tend to develop antibiotic-resistant pathogens.
"Outside hospital, where repeated testing may not be feasible, patients might be best advised to stop treatment when they feel better, in direct contradiction of WHO advice," the researchers say.
The researchers also argued that, when it comes to common bacterial infections, there simply is no evidence to support that stopping antibiotic intake prematurely increases the risk of developing an antibiotic resistant infection. Since this seems to be the case, research is needed to determine the minimum length of time for antibiotic prescriptions.
Doctors Should Determine When To Stop Taking Antibiotics
Of course, it was already clear from the start that the controversial study would not be welcomed with open arms by the medical community; however, not all doctors completely disagree with the researchers. Some experts believe the researchers make a fair point but to only a certain extent.
Most experts believe that the controversial advice should only be considered on a case-by-case basis but that the study's call for research on prescription duration may prove helpful for patients and doctors.
"The evidence for shorter courses of antibiotics being equal to longer courses, in terms of cure or outcome, is generally good, although more studies would help and there are a few exceptions when longer courses are better — for example, TB," St. George's University of London professor of microbial pathogenesis Jodi Lindsay explains.
Royal College of General Practitioners chair professor Helen Stokes-Lampard, on the other hand, defended the practice and explained that most prescriptions are tailor-made to the patient and his or her symptoms. She added that some antibiotic prescriptions are already short so telling patients to further shorten the length by stopping as soon as they feel better is concerning.
"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," Professor Stokes-Lampard said.
Making The Same Mistake
As mentioned earlier, the authors of the controversial study accused that the recommendation to take the full-course or longer antibiotic treatments is not evidence-based, which is why it should be questioned. However, one expert pointed out that Llewelyn and his colleagues also committed the same mistake.
"Arguing that antibiotic course duration is not sufficiently evidence-based is worthwhile, but the editorial essentially argues that patients should not finish their course of antibiotics. This, too, is not evidence-based and increases the likelihood of adverse outcomes for patients disregarding medical advice when a course of antibiotics is clearly warranted," University of Pittsburgh School of Medicine microbiologist Vaughn Cooper argues.
Most experts agree with the authors that more studies are needed to determine the most efficient duration for treatment courses; however, they also agree that recommending patients to stop taking medications based on how they feel alone is irresponsible because it supports a "one-size-fits-all" approach when diseases and their treatments vary.