You need not always complete full course of antibiotics: Doctors
Is it important to complete a full course of
an antibiotic? Yes, according to conventional wisdom, which says stopping a
course mid-way could lead to drug resistance. But several scientists have now
challenged this claim.
In many situations, stopping antibiotics
sooner is a safe way to reduce antibiotic overuse, said a paper published in
the British Medical Journal. "Patients
are put at unnecessary risk from antibiotic resistance when treatment is longer
than necessary," said the authors from Brighton and Sussex Medical School in the UK.
Dr Randeep Guleria, director, AIIMS,
however, warned patients against stopping antibiotics on their own. Stopping or
extending a course of antibiotics "is
a clinician's call", the AIIMS director said, while agreeing that
there was a need to critically look at prescription patterns.
Dr Suranjit Chatterjee, senior consultant, internal medicine at
Apollo hospital said an antibiotic course need not be
treated as sacrosanct. "It can be
de-escalated or stopped if patient's condition improves," he said.
Chatterjee said antibiotics are prescribed to
many patients on an empirical basis if they have high fever or diarrhea. "If tests reveal he or she does not have
typhoid or other serious infections as suspected and this is reflected in his
clinical condition, antibiotic course can be altered," the doctor
said.
Guleria and Chatterjee said in diseases such
as tuberculosis and typhoid, a patient may feel better after a few days but the
antibiotic course still needs to be completed because not doing so increases
the risk of relapse and emergence of resistant bacteria.
Traditionally, antibiotics are prescribed for
recommended duration or courses, say for five to 10 days or more, depending on
the condition.
The BMJ article argued that fundamental to
the concept of an antibiotic course is the notion that shorter treatment will
be inferior. But the scientists pointed out that studies to identify minimum
effective treatment duration have simply not been performed for most
conditions.
"For
example, pyelonephritis (inflammation of kidney due to bacterial infection) has
historically been treated for two weeks. Trials have shown shorter courses of
quinolones are effective (seven days for ciprofloxacin and five days for
levofloxacin), but no such data exist for B-lactams which are the main
antibiotic class used," the BMJ study said. It added that current
international guidelines recommend 10-14 days' treatment with B-lactams, based
purely on absence of data for shorter courses.
The experts also argued that the concept of
an antibiotic course ignores the fact that patients may respond differently to
the same antibiotic, depending on diverse patient and disease factors.
Many bacteria, for example Staphylococcus
aureus, live harmlessly in our body (the gut, skin or mucus membranes). When a
patient takes antibiotics for any reason, species and strains sensitive to it
are replaced by resistant species and strains ready to cause infection in the
future. "The longer the antibiotic
exposure these opportunistic bacteria are subjected to, the greater the
pressure to select for antibiotic resistance," the BMJ article
explains.
Dr Anoop Mishra, chairman, Fortis C-Doc, said
concerns about antibiotic resistance due to overuse are important but they
shouldn't be allowed to prejudice the minds of patients to unilaterally alter
the antibiotic course. "The
compliance rate of medicine prescription is already very low in India. It is a
major cause of emergence of drug-resistant tuberculosis, for example,"
he said.
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