Eh? Other way around, surely?

Doctors must stop telling patients to finish an entire course of antibiotics because it is driving antimicrobial resistance, a group of eminent specialists has warned.

Patients should be encouraged to continue taking medication only until they feel better, to avoid the overuse of drugs, experts from bodies including Public Health England and the University of Oxford are now advising.

Current guidance from the NHS and the World Health Organisation says it is essential to ‘finish a course’ of antibiotics to avoid triggering more virulent forms of disease.

Stopping early means there’s a chance that some of the bug will have been exposed to the antibiotic but not deaded by it. Increasing the chance of resistance, no?

Maybe Woody Allen was right – brown rice kills and steaks cure.

13 comments on “Eh? Other way around, surely?

  1. “But in a new article in the British Medical Journal (BMJ), 10 leading experts said the public health message is not backed by evidence”

    Surely not.

  2. Well well. Another “expert opinion” changing abruptly by 180 degrees.

    But remember – believe experts without question!

  3. ‘Another “expert opinion” changing abruptly by 180 degrees.’

    Yup; like that old rubbish about not swimming soon after a meal, and various other medical superstitions of my youth.

  4. I listened to the bloke behind this on Today, this morning.

    Two things: he sounded… odd. Can’t put my finger on it but sounded like a bit of a quack.

    Also, given he says there’s no evidence to back up the view that courses should be finished, he also acknowledged that there’s no evidence for his -new- view on finishing them early, either. He then followed up by suggesting more research is needed.

    Sounds like an attempt to secure funding for some actual research. I’m split between thinking ‘Good idea’, but I think I’m with Timmy here in that we pretty much *know* that resistance comes from leaving a few of the stronger little blighters alive when finishing a course early, and that he’s in fact a quack who’s just trying to line his pockets.

  5. Lockers,

    …and that he’s in fact a quack who’s just trying to line his pockets.

    Sounds like a certain tuberous Professor of our acquaintance.

    I think I’ll give it a go and hawk myself around a few companies that I’ve worked with in the past – “your IT systems are a pile of crap. I have no evidence for this but if you pay me an obscene amount I’ll look into it for you”

    *Crun exits stage left to go and set up an LLC*

  6. Sounds to me like the modern evidence-based medicine movement.

    Their argument is that there’s a ton of medical practice that was invented before modern double-blind trials, and we haven’t gone back and tested all of that historical practice to make sure it actually works. 90-something per cent. of the time, you prove that it does work the expected way, but there are some that don’t work as expected, and there are enough cases when you turn out not to know what you thought you knew that it makes sense to go back and check.

    And, unlike new drugs, you’re not going to get a private company to fund this because you can’t sell the knowledge thus acquired, so you’re forced to get either the government or charity to give you money – which can mean coming on the Today programme to beg for it.

  7. My niece, a renowned doctor, told me years ago that exporting antibiotics was a key factor in their becoming ineffective. Exactly as you say, Tim, third world countries would administer half-dosage, and/or not run full course of treatment, to conserve the scarce resource.

    Knapton is wrong. Dangerously so.

  8. In recent years in the UK it seems to have become the default for doctors and dentists to only prescribe 5 days worth rather than 7.
    On a number of occasions 5 days didn’t quite kill off the ear or tooth infections I had and I needed to have a second longer course a week or two later.
    In one case I tried to tell the dentist when he asked on the 6th day that OK, I just about feel alright today but the infection was still throbbing last night, but he wouldn’t give me any more tablets – until I had to go back a week later when the infection had flared up again twice as badly.
    I try to insist on having 7 days to start with now.

    I doubt if I’m the only person who has had to have far more antibiotics than necessary later for the sake of a couple of extra days in the first place – and this new advice is only going to make matters worse.

  9. If this research is on to anything, and I think it may be, then the obvious logic would be this. You have thousands of species of bacteria in and on you all the time. One of these is causing a problem so you start taking an antibiotic. After while, enough of that bacteria is killed for your body to get back the upper hand. Now, at that point, stopping might increase chance of resistance in the targeted bug. But antibiotics hit LOTS of bugs. Bacteria have a habit of swapping genetic material, even between species, especially when under stress. And for the extra few days you are taking the antibiotics when you don’t need to, you are exposing thousands of other bugs to it, and encouraging them to find ways to resist it. And once they do, not only are they resistant, but they can swap the resistance genes into other species, including the one that caused the problem in the first place, and others which might cause problems in the future. So resistance might well increase the longer you take the drugs, and that might (MIGHT) outweigh the benefits of always continuing treatments longer than the bare minimum..

  10. Bugs and/or viruses will decimate the human population if not almost wipe it out in the end, whatever we do.

  11. JS – I am prone to some infections. Have lost count of the number of times have had to attend A&E or local walk in centre after an infection has flared up after the antibiotics course finished.
    Can be a half dozen times of 5 day treatments before I get a longer one. For one infection.
    Times that by multiple infections a year.

  12. I’m sure it works both ways – resistance caused by under-use and over-use.

    It’s possible, even, that, after 50 years of overuse, the lower hanging fruit are now in the under-use category.

    Why do people love to criticise medical expertise when life expectancy is clearly getting longer every year?

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