ACCORDING TO DOCTORS - YOU MAY NOT NEED TO TAKE A FULL COURSE OF ANTIBIOTICS

When you last took antibiotics, your doctor probably told you to “complete the course”—that is, take the pills for the length of time prescribed, even if you felt better before the end. But there’s growing evidence that this old-school approach does more harm than good. 

You might assume prescribing lengths are standardized, based on solid scientific principles. Not so, says Professor Jack Gilbert, PhD, faculty director of the Microbiome Center at the University of Chicago. “The length of time we use an antibiotic for is pretty arbitrary.” He says most doctors opt for five to 10 days, but there’s no consensus about where these figures came from.  

“They may reflect long-standing convention or be based on a manufacturer’s decision during an initial drug trial,” according to an opinion piece by infectious diseases specialist Professor Lyn Gilbert.

Related: 5 Natural Powerful Antibiotics You Should Consider

TAKING THE FULL COURSE CAN DO MORE HARM THAN GOOD

Traditionally, doctors have stuck to longer prescribing lengths in order to prevent relapse and out of the belief that it would kill off antibiotic-resistant bacteria. That’s antiquated, says Dr Brad Spellberg, chief medical officer at the Los Angeles County-University of Southern California Medical Center and the co-author of Rising Plague: The Global Threat from Deadly Bacteria and Our Dwindling Arsenal to Fight Them. “The old thinking goes, ‘if you want to prevent resistance, take every last dose of antibiotics’. That makes no sense whatsoever.” 

Over the last 10-15 years, studies have shown that shorter courses than typically prescribed are just as effective for a range of infections, including blood infections, pneumonia, strep, skin infections, and sepsis. It might seem like taking antibiotics for a couple more days than medically necessary wouldn’t be a big deal, but it can be disastrous. 

We each have a personal microbiome around 40 trillion bacteria, viruses and fungi that live on and in us, mostly in the intestine. Normally, they regulate our immune system, metabolic balance, and brain function. Antibiotics rapidly deplete these microbes, says Professor Gilbert, but they usually regrow. “It becomes a problem when an infection takes hold while the microbes are knocked back.” One example of this is C. Difficile, a hospital-acquired infection that causes severe diarrhea and can be fatal. Professor Gilbert also notes that taking antibiotics from a young age could have long-term effects, which might include diabetes and arthritis. One study found a link between childhood antibiotic use and food allergies.  

“There are a whole host of problems that come from disrupting that microbial imbalance that are not fully appreciated yet by medical science,” says Dr Shira Doron, an associate professor of medicine at Tufts University School of Medicine and an antimicrobial steward at Tufts Medical Center. “We still don't know the extent to which antibiotic use might be creating harm.”

There are some exceptions, such as patients with tuberculosis, who need months of uninterrupted treatment, or people undergoing chemotherapy who have no immune system to speak of. But if you’re otherwise healthy, taking only enough antibiotics to kill most of the infection-causing bacteria should be enough: your body’s natural defences will kick in and clear the rest.

Related: The Dangers Of Antibiotics - Are Antibiotics Safe and Effective?

 

OVERUSING ANTIBIOTICS ENCOURAGES ANTIBIOTIC-RESISTANT BACTERIA

What is clear is that antibiotic-resistant bacteria is an increasing problem. Some amount of resistance is inevitable: we all have microbes in our bodies that produce antibiotics other modules have evolved to resist. But overly-zealous prescribing practices and a lack of new drugs have hastened the speed with which the bacteria in our bodies is becoming resistant to antibiotics, which, should we have surgery or injure ourselves, creates the ideal environment for drug-resistant superbugs like MRSA (meticillin-resistant Staphylococcus aureus) to flourish.

According to the Centers for Disease Control (CDC), 30-50% of antibiotics used in inpatient settings and 30% of antibiotics prescribed by GPs are unnecessary—used for viruses or colonization (where a patient has bacteria that suggests an infection but zero symptoms), which only encourages resistant bacteria to thrive. 

Dr Spellberg says part of the problem is that there’s no way to tell whether someone has a bacterial or viral infection just by looking at them. “We know that if you come in saying, ‘I have a fever and I'm coughing and I have a sore throat’, 95% of the time it's viral. But you can't rule out the small possibility that it's bacterial, and people don't want to make a mistake. So, they say, ‘well, how much harm can this one prescription do?’ If that happens 10 times per year, indeed no harm will come. When it happens millions of times per year, there are catastrophic societal consequences.” 

Every year, two million people in the U.S contract antibiotic-resistant infections 23,000 of whom die. Worldwide, the Healthcare Infection Society, which works to prevent infections associated with healthcare, predicts that figure will be 10 million by 2050. This won’t only affect people who’ve taken antibiotics. “You can't see it but everything in the world is covered with a thin layer of faeces,” says Dr Doron. “So you're being exposed to other people's gut flora without realizing.” 

One way to slow down the spread of resistance? Antibiotic stewardship: a range of initiatives aimed at choosing the right drug, dose, and duration for each patient, all of which are equally important in terms of reducing unnecessary use (and thus slowing the spread of resistance). Part of this is encouraging the use of narrow-spectrum antibiotics (especially in outpatient care), which kill fewer healthy bacteria than broad-spectrum antibiotics, which are more commonly used as they quickly treat a wide range of infections. 

Dr Doron says that around 40-60% of hospitals currently have antibiotic use protocols in place. Fewer nursing homes do, although the Centers for Medicare and Medicaid Services (CMS) made it a requirement for 2017. Aside from this, there’s no national regulation or monitoring of stewardship standards. In future, Dr Doron would like to see centralized data collection so states can track their antibiotic resistance and compare it to other states. 

 

WHAT YOU SHOULD DO 

On an individual level, no one’s suggesting that you stop taking antibiotics against your physician’s advice. If you are prescribed a course, Professor Gilbert suggests you check whether it’s medically necessary or just what your doctor thinks you expect. If it is necessary, Dr Spellberg’s recommendation is to call your doctor if you feel better sooner than expected and check whether you can stop taking them sooner. The World Health Organization’s report on antibiotic resistance backs this up: “Because the rate of antibiotic resistance tends to increase with the total amount of antibiotics used, the general rule might be: the shorter the course, the lower the risk of resistance.” 

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