Is it time to drop the ‘complete the course’ message for antibiotics?

Is it time to drop the ‘complete the course’ message for antibiotics?

Oxford researchers are among a group of infectious disease experts to argue that the advice that patients should complete a course of antibiotics is not supported by evidence and should be dropped.

In a paper published in The BMJ , the authors, who include National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) professors Tim Peto and Sarah Walker, say that patients are being put at unnecessary risk from antibiotic resistance when treatment is given for longer than necessary, not when it is stopped early.

They say it is time for policymakers, educators and doctors to drop the ‘complete the course’ message and state that it is not based on evidence.

Prof Peto said: 'The notion that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence. At the same time, taking antibiotics for longer than is necessary increases the risk of resistance.'

The analysis, which was led by Prof Martin Llewelyn of Brighton and Sussex Medical School, was done for the ARK-hospital PGfAR programme, and for the NIHR’s Health Protection Research Unit at Oxford University.

Oxford University Hospitals NHS Foundation Trust is one of the leading collaborators in ARK-hospital, an NIHR-funded research programme aiming to safely reduce antibiotic use in hospitals.

Prof Walker, co-theme lead for Antimicrobial Resistance and Modernising Microbiology at the Oxford BRC, added: 'One reason why the ‘complete the course’ advice is so resilient is that it is clear, simple and unambiguous, and the behaviour it calls for is easily followed. But evidence suggests that, often, stopping antibiotics sooner is a safe and effective way to reduce antibiotic overuse.

'Completing the course also goes against one of the most fundamental and widespread medication beliefs people have – that we should take as little medication as necessary.

'Antibiotics are a precious and finite natural resource which should be conserved by tailoring treatment duration for individual patients,' she added.

The team are calling for more research to develop simple, alternative messages, such as ‘stop when you feel better’. They say that clinical trials are needed to determine the most effective strategies for optimising the duration of antibiotic treatment.

The full paper, 'The antibiotic course has had its day,' can be read in the The BMJ.