Accepted antibiotic advice ‘driving antimicrobial resistance’

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Doctors must stop advising people to finish prescribed courses of antibiotics because it is increasing the threat of antimicrobial resistance, health experts have warned.

Eminent specialists from bodies including the University of Oxford and Public Health England now say that to avoid overuse of antibiotic drugs, patients should instead be advised to only take them until they feel better. 

This new advice is in contradiction to current guidance from the NHS and the World Health Organisation that says it is essential to ‘finish a course’ of antibiotics. The theory behind the guidance was that failing to take enough tablets would allow bacteria to mutate and become resistant to the drug.

However, an article from 10 experts in the British Medical Journal (BMJ) said that the health message is not backed by evidence and should be dropped. They claim that the guidance in fact puts the public at growing risk from antimicrobial resistance.

Lead author Martin Llewelyn, professor of infectious diseases at Brighton and Sussex Medical School, said: “Historically, antibiotic courses were driven by fear of undertreatment, with less concern about overuse.

“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.

“We encourage policy makers, educators, and doctors to stop advocating ‘complete the course’ when communicating with the public.”

Alexander Fleming was the first to give the so far accepted advice in his Nobel Prize acceptance speech in 1945, saying: “If you use penicillin, use enough.” He found that bacteria become ‘acclimatised’ quickly to penicillin and patients who took insufficient doses could transmit a more dangerous strain to family members.

In the article the experts argue that when a patient takes any antibiotics it allows dangerous strains of bacteria to grow on the skin and gut which could cause problems in the future. The longer the course, the more the resistance builds, the article said. 

Chief medical officer Dame Sally Davies responded however by saying that further research was needed before the guidance to patients should change: “The message to the public remains the same: people should always follow the advice of healthcare professionals. To update policies, we need further research to inform them.

“The Department of Health will continue to review the evidence on prescribing and drug resistant infections, as we aim to continue the great progress we have made at home and abroad on this issue.”