The rule that patients have to ‘finish the course’ of antibiotics is wrong, experts claim

It’s a rule that all of us are familiar with, having been reminded endlessly by doctors and instructions on pill bottles – you MUST finish the course of antibiotics.

Traditionally, doctors have told patients that failing to finish the course is ‘irresponsible’ – because it could increase antibiotic resistance.

But could that advice be wrong? A controversial new report suggests that not only is ‘finishing the course’ unnecessary, it can be dangerous.

Professor Martin Llewelyn of Brighton and Sussex and colleagues published their analysis in British Medical Journal.

Professor Llewellyn says, ‘Historically, antibiotic courses were driven by fear of undertreatment, with less concern about overuse.

‘The idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence, while taking antibiotics for longer than necessary increases the risk of resistance.’

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The advice of the NHS and the World Health Organisation remains that patients should finish the course – and Professor Helen Stokes-Lampard, chairman of the Royal College of GPs, said patients should not change their behaviour based on one study.

The researchers write, ‘The idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence, while taking antibiotics for longer than necessary increases the risk of resistance.’

Professor Llewellyn says, ‘Historically, antibiotic courses were set by precedent, driven by fear of under-treatment, with less concern about overuse…

‘Completing the course goes against one of the most fundamental and widespread medication beliefs people have, which is that we should take as little medication as necessary.’

The researchers say that some diseases such as tuberculosis can become resistant if the drugs are not taken for long enough – but this is not the case with most illnesses.

Most bacteria which make people ill are found widely in the community – and bacteria such as Staphylococcus aureus only make people ill when they get into the bloodstream or the gut.

The researchers say that finishing a course of antibiotics is likely to make those bacteria more resistant.