A crash course in antibiotic use

by Sodhi N Science Writer, AVA
21 Aug 2017
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Traditional medical advice has been to always complete the course of antibiotics, with even the World Health Organization recommending patients complete their full prescription. The thinking behind this advice is that it will help prevent antibiotic resistance. But, with antibiotic resistance becoming a global threat to human health, it seems this advice is being challenged.

There are now calls to rethink this paradigm, with the authors of an article recently published in the British Medical Journal suggesting the current advice to 'complete the course' may, in fact, be driving resistance.1 The authors argue that available evidence does not support the idea that stopping antibiotic treatment early encourages antimicrobial resistance.

The authors also point to unintended collateral damage – the longer the course the higher the likelihood that harmless commensal bacteria in the gut or on the skin will be sufficiently exposed to antibiotic concentrations to preferentially select those carrying resistance mechanisms. Resistance in commensals provides a reservoir of resistance genes that can then transfer to more pathogenic bacteria, endowing them with resistance and making them less vulnerable to future antibiotic treatments.

The key message the authors are trying to get across is that there needs to be the acknowledgment by the medical profession that the ‘complete the course’ philosophy for antibiotic use is outdated and may be doing more harm than good.

AVA spokesperson Dr. Stephen Page said, “What constitutes a course of antibiotics? Usually, it’s what comes in the pack, but there is no consensus on how many capsules or tablets in a packet. And with numerous factors affecting the efficacy of antibiotics in individual patients, clearly, one size does not fit all.”

Shorter and more personalised courses of antibiotics could be the answer, with many available studies showing no increased risk of resistance with shorter courses.1 There is a call for more research to establish minimum treatment times for all antibiotic classes and how to determine when enough is enough. Also, the public need to be better informed on the limitations of antibiotics, with the need to restrict their use to bacterial infections rather than viral infections.

“Until there is better evidence for the efficacy of shorter courses, veterinarians should continue to use their professional judgement when prescribing antibiotics and clients should closely follow the recommended treatment plan prescribed by their veterinarian,” Dr. Page said. And, as per the AVA’s policy on the use of antimicrobial drugs in veterinary practice, veterinarians should stress the importance of preventive health care to reduce the risk of infection and need for antimicrobial therapy.

This article appeared in the September 2017 issue of the Australian Veterinary Journal

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