Piqued Lite - 7/28/2017 - Antibiotic Courses May Be Too Long And More Research Is Needed To Decide On New Course Length - The BMJ
Edit: The first edition of this post implied that the conclusion of the scientific study cited was to use antibiotics "until you feel better." This is not the case. The relevant conclusion of the study is quote:
Clinical trials are required to determine the most effective strategies for optimising duration of antibiotic treatment
Edit 2: This does not mean you should unilaterally cut down on your course of antibiotics. Until new guidelines come out following your doctor's prescription is the only safe choice.
Almost every doctor on earth recommends finishing a course of antibiotics once you've started.
If you read the instructions that come with any antibiotic prescription, you've no doubt seen the same recommendation made there as well. If you google the question, the internet as a whole will, for the most part, give you the same resounding answer.
Ostensibly, the purpose of this long standing advice has been simple: if you stop using antibiotics when you feel better, instead of using the whole course, you may may fail to totally wipe out the invasive bacteria, and the few bacteria you left behind will now be more likely to have developed resistance to the antibiotic you used.
As the research paper from the BMJ mentions, the fear of under dosing antibiotics stems from the very early days of antibiotic treatment. From the very start there was a real fear of not giving enough antibiotics and thereby inadvertently breeding antibiotic resistant bacterial strains.
This idea is engrained in the use of antibiotics worldwide. Indeed, I have been guilty of escoriating friends and family for failing to do this.
So imagine my surprise to discover that:
For common bacterial infections no evidence exists that stopping antibiotic treatment early increases a patient’s risk of resistant infection.
You read that right, apparently this has been a quietly changing norm for some time. Even the CDC changed their antibiotic use language from supporting completion of a full antibiotic course to "use as prescribed."
So where does this leave us exactly? It would appear that common practice regarding the course of antibiotics may simply be wrong. Certainly the BMJ, which is a prestigious journal, takes an unequivocal position that "shorter treatment is clearly better for individual patients." The best advice, moving forward, is not yet clear, but the BMJ recommends further clinical study to come up with a clearer answer on what time tables make the most sense.
Info Source
http://www.bmj.com/content/358/bmj.j3418
Picture Source:
[1]Bmramon at English Wikipedia CC BY-SA 3.0 via Wikimedia Commons
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Use as prescribed means take the full prescribed course. Now whether or not the length of a course should be changed is up to the data, science and physicians. What people should not do is decide that length of the course on their own. I disagree with this BMC article. Or at least your interpretation (I haven't read the article to draw my own).
People shouldn't stop taking their prescriptions "when they feel better" there is no evidence to support that being even remotely acceptable.
I was fairly surprised as well - is The BMJ a legit scientific journal? I may be incorrect - but if it is not then i will blank out the post.
If it is legit, then I would be very interested in your interpretation of the study
BMJ is a fine journal. I'll have to look at the study.
Edit: you summarized their opinions appropriately (this is an opinion article). I disagree that "stop when you feel better is an appropriate message." Infections can recur if you stop an antibiotic too soon, and "when you feel better" gives people too much wiggle room in that regard.
Their desire to minimize unnecessary medication is good, and supported by data, and as such they should be advocating more study as to appropriate dosing of antibiotics to allow physicians to make more targeted prescriptions. Allowing for significantly shorter durations of exposure. Rather than telling people, well you decide when your cured. It's just difficult to know if the infection is beaten back enough...
Hi believe your interpretation is correct - and looking at the phrasing of the fonal sentence, i think i was trying to imply the answer is not obvious rather than that that "us until you feel better" was the final conclusion of the study.
I have removed the final sentence, and added a large edit to the front end explaining clearly the actual conclusions.
I think i misinterpreted the conclusion - edits forthcoming
Here is what I mentioned in krnel's post regarding this BMJ journal:
"the "full" course, it is vaguely described, if a doctor prescribe a two days course (which in the past might be 10 days), the post of not taking the full course become misleading!! "
I do agree that we might need to optimize the dosage of the antibiotics treatment, but people misinterpreting the "full course" will be fatal.
I will still recommend people to finish the prescribed dose, as probably most of us are not medical doctors, and failing to take appropriate treatments will likely mean we miss the golden treatment window, it is always us that suffers in the end.
MOST IMPORTANT OF ALL:
let's not take the journal "quality" as a standard reference, we all have seen that Lancet published the antivaccine paper which they later regretted it ; ]
You're absolutely right re:Lancet - and I've added a second edit and redited the title again - lol - to make even clearer that people should follow their
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