Antibiotic Action and BSAC respond to Recent BMJ Article on Antibiotic Courses

The British Society for Antimicrobial Chemotherapy (BSAC) has noted with interest publication in the BMJ of the opinion piece by Llewellyn et al on need to consider when it is appropriate to stop taking antibiotics, and the apparent lack of evidence to support completion of courses as it current policy.

Speaking on behalf of BSAC the President, Professor Dilip Nathwani OBE said:

At this point in time the British Society for Antimicrobial Chemotherapy is unable to support the call to drop the ‘complete the course of antibiotics’ proposed by Llewellyn and Peto, but would be open to further debate.  The evidence they offer in support of their call is sparse and their advice is potentially very confusing for patients.  Much clearer evidence and advice are needed before changes in policy are considered, as are further studies to assess the harm that stopping antibiotics early might cause patients, particularly those in high risk or vulnerable groups such as the very young, elderly and those unable for whatever reason to make decisions about their treatment options.”

He continued,

Furthermore the suggestion that patients should stop taking antibiotics ‘when they feel better’ is too subjective, and at best will lead to a potential stockpiling of unused antibiotics for future use without first seeking the advice of a doctor, and at worst inappropriate use that would almost certainly contribute to a rise in antibiotic resistance ratesThe decision to end antibiotic treatment early should be a clinical decision.”

Professor Laura Piddock, BSAC Chair in Public Engagement, Director of Antibiotic Action said this:

‘As every patient requirement can be different we don’t know how long a course of antibiotics should be, so a generic question about when to stop treatment is unanswerable.  However, for certain bacterial species laboratory research shows that it can take many days to completely eradicate an infection. Research in patients is urgently needed to show how long antibiotics must be taken to kill the bacteria causing commoninfections.”

Dr Nick Brown, BSAC Council Member and Consultant Medical Microbiologist, said:

“There is a real risk that the message ‘it is OK not to complete the course’ could be interpreted by patients as a licence not to comply with other dosage instructions. That is, take an antibiotic once a day instead of twice a day, etc. This could result in under treatment and encourage the development of resistance. Having said that, I agree with the concept that, in general, treatment courses are too long and poorly evidenced-based. So, clearly, more work needs to be done in this area – and urgently.”

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