Antibiotics — Do we need to complete the full course?

A group of ten key opinion leaders in the United Kingdom have just released an opinion piece in the British Medical Journal suggesting people prescribed antibiotics should not complete the full course and in fact cease the pills when they start to feel better. The suggestion from these experts was that completing a course of antibiotics is a major factor in the generation of antibiotic resistance.

So, do we actually need to complete the full course of antibiotics once prescribed? Well, in my opinion, this is absolutely the wrong question. The correct question, in this case, is “should the antibiotics have been prescribed in the first place?” It is my opinion that the major reason for antibiotic resistance is that for the past 70–80 years, doctors and veterinarians have been over-prescribing antibiotics. The excessive prescription of antibiotics for human patients, animals and the use in many feeds for domestic livestock is in no doubt the major reason for the dreadful problem of antibiotic resistance and now the generation of super bugs.

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It is estimated that in the United States alone there are 20 million unnecessary prescriptions written for antibiotics every year and there are 23,000 deaths associated with super bugs which are resistant to if not all, the vast majority of commonly used antibiotics.

Until the last decade or so, antibiotics were commonly prescribed for viral illnesses such as the common cold or influenza. Doctors would use the argument ‘I am giving you the antibiotic just in case you develop a bacterial infection’. This is an incredibly flawed argument and in fact if you take an antibiotic when you have a viral illness it wipes out your normal bacteria which are vital in the body’s defence against viruses. Thus, antibiotics prescribed with viral illnesses can, in fact make them worse. To date, we only have a few very specific anti-viral agents that are effective for many of the herpes infections and certainly antiretroviral agents used in the treatment of HIV-AIDS.

Whether you take an antibiotic for a couple of days or for the full course which is typically 5 days in my view will hardly make a dent either way in the prevention or generation of antibiotic resistance. The only way we will see any change in this pattern of prescription is if doctors are only allowed to prescribe antibiotics with a proven bacterial infection. For example, if you have a sore throat, the doctor should swap your throat and wait the 24 hours or so until the cultures returned to determine whether you have a true bacterial cause for the sore throat.

In obvious cases of bacterial infection, such as a urinary tract infection so common in women, all that is necessary is the collection of the urine specimen and the immediate prescription of antibiotics as viruses do not cause urinary tract infections. The vast majority of sputum producing bronchitis infections are due to viruses and again antibiotics have no real place but are commonly prescribed in this setting, especially if the sputum is very green. Again, to obtain a sputum culture in this situation and prescribe antibiotics only if there is a bacteria present is the most logical, cost-effective and most appropriate way of preventing the ongoing march of antibiotic resistance.

Unfortunately, this needs to be a worldwide phenomenon possibly coordinated by the WHO and new medical regulations need to be introduced across the board to ensure the prescription of antibiotics becomes a restricted practice.

Experts have been warning for years of the advent of the post antibiotic era returning us to a situation where healthy people may be dying from previously very treatable conditions such as pneumonia, tonsillitis and urinary tract infections, not to mention the more serious long-term bacterial infections such as osteomyelitis (infection of the bone), tuberculosis and many sexually transmitted infections.

As with many situations, science advances funeral by funeral and I suspect the attitude of antibiotic therapy will be in the same vein but unfortunately it may be the funeral of many other innocent people.

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Dr Walker is an expert in the field of preventative cardiology and has published seven books. He gives lectures nationally and internationally.

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