What is the evidence around how long to take antibiotics for, and why are there concerns about overuse of antibiotics? The reason behind this is widely regarded to be that there is a risk of the infection returning if the antibiotics are stopped early. A group of researchers have suggested that not only is it not necessary to finish a course of antibiotics, but that finishing the course could actually be increasing antibiotic resistance — the growing problem of bacterial strains becoming resistant to antibiotics and therefore ineffective.
The researchers have published a review, which was published in the British Medical Journal , arguing that the advice to always finish a course of antibiotics is not backed up by evidence. The advice about finishing a course is thought to go all the way back to when antibiotics were first used, during the s. The review also highlights the fact that different people respond differently to antibiotics, and that the recommendations for the length of time to take antibiotics for do not take that into account, and is in fact often an arbitrary timeframe.
The British Society of Antimicrobial Chemotherapy is sceptical of this simplistic message, however. They have called for urgent research to identify all those infections that do not need to be treated with antibiotics, and to identify the most effective length of treatment for those infections that do.
Doctors and patients should always discuss the pros and cons of antibiotics and, if prescribed, what course length is appropriate. NHS and Public Health England advice is still to take antibiotics for as long as your doctor tells you to. This is just one study, they warn, and not the basis for a change in prescribing policy. Antibiotic resistance can build up after bacteria have become repeatedly exposed to antibiotics.
The bacteria change or adapt so they are no longer affected by the antibiotic. This renders antibiotics ineffective against infections they were previously able to treat.
It has been widely accepted that stopping antibiotic treatment early encourages bacteria to develop antibiotic resistance. As a result, current medical advice is to finish taking a prescribed course of antibiotics as recommended by a healthcare professional, even if you start to feel better. This review challenges current medical advice by suggesting that concerns around antibiotic treatment are driven by fears of "under-treatment", where the course of antibiotics doesn't last long enough to clear any infection, when the concern should be more about over-use.
The authors of the piece make the point that when antibiotics were first used during the s, there was little awareness of the problems of antibiotic resistance, so the concept of "over-use" was never even considered. The researchers of this narrative review say they have used data from randomised controlled trials RCTs and observational cohort studies to inform the points made. However, there is no clear methodology so we don't know how the evidence was chosen and whether it was systematic in manner.
So the reviewers run the risk of being accused of picking the evidence to support their hypothesis. When testing a hypothesis like this, a systematic review or meta-analyses would have been the best approach to reviewing the evidence. This narrative review challenges current medical advice that patients should complete their course of antibiotics, by suggesting that concerns around antibiotic treatment are driven by fears of under treatment, when we should instead be concerned about over use.
The opinion piece, by a team of researchers from across England, argues that reducing the use of antibiotics is essential to help combat the growing problem of antibiotic resistance. Prof Martin Llewelyn, from the Brighton and Sussex Medical School, together with colleagues, argues that using antibiotics for longer than necessary can increase the risk of resistance.
He suggests traditional long prescriptions for antibiotics were based on the outdated idea that resistance to an antibiotic could develop when a drug was not taken for a lengthy time and an infection was undertreated. Instead, he says, there is now growing evidence that short courses of antibiotics - lasting three to five days, for example - work just as well to treat many bugs.
He accepts there are a few exceptions - for example, giving just one type of antibiotic for TB infections - which is known to lead to rapid resistance. But the team says it is important to move away from blanket prescriptions and, with more research, give antibiotic prescriptions that are tailored to each infection and each person. The study acknowledges that hospitals are increasingly reviewing the need for antibiotics from day to day and that there is a growing trend towards shorter courses of drugs.
But it questions whether advice such as stopping once feeling better would be beneficial - particularly when patients do not get the opportunity to be reviewed in the hospital every day. Causes of antibiotic resistance include:. These are the ways you can help prevent antibiotic resistance:.
We can make a difference to prevent antibiotic resistance. Ask your doctor if antibiotics are really necessary to treat your infection. Follow the instructions of your health care practitioner carefully to make sure that you use the prescribed medicine correctly. Butler westerncape. Skip to main content. Search form Search this site.
0コメント