Volume 202 - Issue 11
Knowing when to stop antibiotic therapy
Author: Gwendolyn L Gilbert
Med J Aust 2015; 202 (11): 570-572. || doi: 10.5694/mja15.00348
Published online: 15 June 2015
Published online: 15 June 2015
Unnecessary or unnecessarily long courses of antibiotics promote resistance
In reply: Thompson and colleagues make an important point: contradicting dogma about the need to complete an antibiotic course is risky and potentially confusing.
My article1 was not written for patients, but it attracted media interest and public comment.2,3 I did not suggest that patients stop taking antibiotics as soon as they feel better, as some assumed2 — although I suspect many do.
Clearly whether they can do so safely, depends on the indication. It would be reasonable for a patient to ask, if the doctor has not explained, whether completing the course is necessary. If, as I suspect is still common, the antibiotic was prescribed for an acute respiratory infection, it is certainly sensible to stop when symptoms improve — albeit better not to have started.
Even when there is a good indication for taking antibiotics, pack sizes often do not correspond with recommended course durations,4 and both are often based on limited evidence. Shorter courses are likely to be just as effective for many infections.5 We need more evidence and more common sense, because unnecessary or unnecessarily long antibiotic courses promote resistance.6
Competing interests
No relevant disclosures.
References
- Gilbert GL. Knowing when to stop antibiotic therapy. Med J Aust 2015; 202: 121-122. _Ref420496124
- Dillner L. Can I stop taking antibiotics as soon as I feel better? The Guardian 2015; 16 Mar. http://www.theguardian.com/lifeandstyle/2015/mar/15/can-i-stop-taking-antibiotics-as-soon-as-i-feel-better (accessed May 2015).
- Nogrady B. Antibiotics — when is enough enough? ABC Health and Wellbeing. http://www.abc.net.au/health/features/stories/2015/03/17/4199436.htm (accessed May 2015).
- McGuire TM, Smith J, Del Mar C. The match between common antibiotics packaging and guidelines for their use in Australia. Aust N Z J Pub Health. In press. _Ref420496917
- El Moussaoui R, de Borgie CAJM, van den Broek P, et al. Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community-acquired pneumonia: randomized, double-blind study. BMJ 2006; 332: 1355-1361. _Ref420496933
- Costelloe C, Metcalfe C, Lovering A, et al. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ 2010; 340: c2096. _Ref420496934