World Antibiotic Awareness Week: Study Says You May Opt Not to Complete Antibiotic Courses

‘Make sure you complete your course of antibiotics!’This instruction has been drilled down your throat along with the bitter pills every time you visit your doc with an infection.A new study published in the British Medical Journal is turning conventional antibiotic wisdom on its head by claiming you don’t always have to finish your course. You can stop once you start ‘feeling better.’The study published in the British Medical Journal goes further and challenges the very premise that not completing the course adds to the burden of antibiotic resistance.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.Most doctors and experts have always said that completion of your antibiotic course is almost a moral obligation. World Health Organisation advises patients to “always complete the full prescription, even if you feel better, because stopping treatment early promotes the growth of drug-resistant bacteria.”The current study encourages policy makers, educators, and doctors to stop advocating “complete the course” when communicating with the public. Further, it advises that "they should publicly and actively state that this was not evidence-based and is incorrect.”To Complete or Not to Complete?So what should you do? What is the advice for patients here in India? The decision to prescribe courses was borne out of the need that the patient will have not take ‘enough’ to get treated.We spoke with experts to understand the messaging.Dr Sumanth Gandra, infectious diseases physician and Resident Scholar at the Center for Disease Dynamics, Economics & Policy says, the decision on HOW LONG should antibiotics be given has not been studied enough. There is lack of empirical evidence on the duration of treatment for most infections except those that have been specifically examined.For example, we know that antibiotics to fight Tuberculosis HAS to be taken for six months. A recent study on ear infections in toddlers says antibiotics should be given for 10 daysDr Sumanth GandraSo, who designed these 7, 10, 14-day courses?He explains that almost 75 percent of antibiotics are prescribed to outpatients.“In hospitalised settings, doctors make the decision to continue or discontinue antibiotics on a daily basis. For outpatients, that’s not possible. Doctors play safe and advise depending upon the condition of the patient.”Dr Surenjit Chatterjee, Internal Medicine doctor at Apollo Hospital, Delhi, says the reporting on this study has been false and misleading.Of course, if you take antibiotics for a longer course than required, resistance develops, but the call on when should the course end, should it end before its due date or not should be entirely the doctor’s call based on how the patient is responding. The community cannot start taking any such decisions on their ownDr Surenjit Chatterjee, Internal Medicine, Apollo Hospital The truth about antibiotic resistance is real. We are not producing new classes of antibiotics and drug-resistant bacteria is rampant. So the new study has to be seen in perspective.Any overuse should be avoided.The US Centre for Disease Control and the UK National Health has already changed its advisory from ‘always complete the course’ to ‘use as prescribed.’‘Make sure you complete your course of antibiotics!’This instruction has been drilled down your throat along with the bitter pills every time you visit your doc with an infection.A new study published in the British Medical Journal is turning conventional antibiotic wisdom on its head by claiming you don’t always have to finish your course. You can stop once you start ‘feeling better.’The study published in the British Medical Journal goes further and challenges the very premise that not completing the course adds to the burden of antibiotic resistance.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.Most doctors and experts have always said that completion of your antibiotic course is almost a moral obligation. World Health Organisation advises patients to “always complete the full prescription, even if you feel better, because stopping treatment early promotes the growth of drug-resistant bacteria.”The current study encourages policy makers, educators, and doctors to stop advocating “complete the course” when communicating with the public. Further, it advises that "they should publicly and actively state that this was not evidence-based and is incorrect.”To Complete or Not to Complete?So what should you do? What is the advice for patients here in India? The decision to prescribe courses was borne out of the need that the patient will have not take ‘enough’ to get treated.We spoke with experts to understand the messaging.Dr Sumanth Gandra, infectious diseases physician and Resident Scholar at the Center for Disease Dynamics, Economics & Policy says, the decision on HOW LONG should antibiotics be given has not been studied enough. There is lack of empirical evidence on the duration of treatment for most infections except those that have been specifically examined.For example, we know that antibiotics to fight Tuberculosis HAS to be taken for six months. A recent study on ear infections in toddlers says antibiotics should be given for 10 daysDr Sumanth GandraSo, who designed these 7, 10, 14-day courses?He explains that almost 75 percent of antibiotics are prescribed to outpatients.“In hospitalised settings, doctors make the decision to continue or discontinue antibiotics on a daily basis. For outpatients, that’s not possible. Doctors play safe and advise depending upon the condition of the patient.”Dr Surenjit Chatterjee, Internal Medicine doctor at Apollo Hospital, Delhi, says the reporting on this study has been false and misleading.Of course, if you take antibiotics for a longer course than required, resistance develops, but the call on when should the course end, should it end before its due date or not should be entirely the doctor’s call based on how the patient is responding. The community cannot start taking any such decisions on their ownDr Surenjit Chatterjee, Internal Medicine, Apollo Hospital The truth about antibiotic resistance is real. We are not producing new classes of antibiotics and drug-resistant bacteria is rampant. So the new study has to be seen in perspective.Any overuse should be avoided.The US Centre for Disease Control and the UK National Health has already changed its advisory from ‘always complete the course’ to ‘use as prescribed.’(We all love to express ourselves, but how often do we do it in our mother tongue? Here's your chance! This Independence Day, khul ke bol with BOL – Love your Bhasha. Sing, write, perform, spew poetry – whatever you like – in your mother tongue. Send us your BOL at bol@thequint.com or WhatsApp it to 9910181818.)

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Always Complete Antibiotic Courses? Study Says You May Opt Not to

A new study calls out the advice that you should always complete your antibiotic courses.

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Topics: Health Antibiotics Antibiotic Resistance