You need not always complete full course of antibiotics: Doctors

NEW DELHI: 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.