When you’re prescribed a course of antibiotics, it’s important to finish the whole thing. At least, that’s the message that’s been perpetuated for years by doctors, nurses, parents and the media. But now, a group of British doctors are making the case that in most cases, it’s time to drop the “complete the course” mantra, which they say could be doing more harm than good.
In a new analysis in the BMJ, health experts from Brighton and Sussex Medical School, the University of Oxford and other institutions say that the idea that cutting short a course of antibiotics will encourage drug resistance is not supported by evidence. In reality, they say, taking more antibiotics than needed does lead to resistance.
The statement in question “can be traced back to the dawn of the antibiotic era,” the authors wrote in their analysis. Alexander Fleming’s early work showed that sensitive bacteria could be “acclimatized” to penicillin, and in 1945, he spoke about a man who didn’t take enough of the drug and passed strep throat—now in a drug-resistant form—onto his wife, who died from the infection.
“If you use penicillin, use enough!” Fleming said at the time. But the authors point out that Streptococcus bacteria has never been shown to develop resistance to penicillin and that other early observations also remain unproven by modern research.
On the other hand, the researchers say, modern science has shown that unnecessary antibiotic use does contribute to the epidemic of drug-resistant bacteria. That includes antibiotics that are prescribed when they’re not needed at all (for viral illnesses, for example), as well as when they’re taken even after a patient feels better.
The researchers say that the directive to always finish antibiotics is incorrect and not evidence-based, and that new clinical trials should determine the best lengths of treatment for specific conditions and situations. Not only is the message potentially harmful, they write, but it
goes against one of the most fundamental and widespread medication beliefs people have, which is that we should take as little medication as necessary.”