Should we really complete course of antibiotics?

For years patients have been told to "complete the course" of antibiotics or risk resistance but some experts are now saying that the opposite is true.

Antimicrobial resistance is more of a threat if a patient has treatment for too long, than it is if a patient stops treatment too early, according to Professor Martin Llewelyn at Brighton and Sussex Medical School and his colleagues.

In an article in the British Medical Journal, they said that, in many cases, there have been no studies to work out the minimum effective course of treatment.

Also, for common bacterial infections, there is no evidence that stopping treatment early increases the risk of resistant infection, they added.

Instead, each course should be tailored to the individual patient and alternative messages should be considered, such as "stop when you feel better".

In the article, the group said that the instruction to "complete the course" is "based on poor evidence".

"This situation is changing in hospital practice, where biomarkers of treatment response can guide when to stop antibiotic treatment," Professor Llewelyn and his colleagues wrote.

"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 (World Health Organisation) advice."

The article comes amid concerns about the increasing threat of antimicrobial resistance, which could see common medical procedures such as joint replacements and caesarean sections become life-threatening.

Around 700,000 people globally already die from drug-resistant infections such as TB and malaria.

Royal Pharmaceutical Society spokesman and consultant pharmacist Dr Kieran Hand, said the article was a "welcome opening of the debate in the UK on the relationship between the length of a course of antibiotics, efficacy and resistance".

He added: "As the researchers have pointed out, further research is needed before the 'finish the course' mantra for antibiotics is changed and any alternative message such as 'stop when you feel better' can be confidently advocated."

He said it was also important to consider what might be done with the leftover antibiotics after a patient has stopped treatment, suggesting they could be taken to a pharmacy.

"The ideal future scenario would be that the right length of treatment for a specific infection for patients is identified from clinical trials and the exact quantity needed is prescribed and dispensed."

The Government's chief medical officer, Professor Dame Sally Davies, said: "The message to the public remains the same - people should always follow the advice of healthcare professionals.

"To update policies we need further research to inform them.

"The Department of Health will continue to review the evidence on prescribing and drug resistant infections, as we aim to continue the great progress we have made at home and abroad on this issue."