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RCGP urges patients to finish courses of antibiotics despite expert claims

RCGP has said new expert claims that doctors should advise patients not to finish antibiotics courses will only ‘confuse’ people.

Experts have claimed that the reasons for advising patients to complete courses of antibiotics and not stopping them if they feel better are largely historical and not based in current evidence.

The authors, writing in a BMJ Analysis article, state that the clinical threat of antibiotic resistance stems mainly from opportunistic pathogens, such as S. aureus and Pseudomonas – bacteria that are usually harmless but can opportunistically cause disease.

The longer these bacteria are exposed to antibiotics, the greater the pressure to select for resistance to the drugs, which can then be passed on to other bacteria of different species.

The authors also claim that the evidence for standard durations of antibiotic courses is weak, with some studies showing that much shorter courses are just as efficient as longer courses in clearing disease. They also assert that for the opportunistic pathogens, there is no trial data to suggest an increased risk of resistance in patients taking shorter antibiotic courses.

They said in the article: ‘The fallacious belief that antibiotic courses should always be completed to minimise resistance is likely to be an important barrier to reducing unnecessary antibiotic use in clinical practice and to developing evidence to guide optimal antibiotic use.

‘Research is needed to determine the most appropriate simple alternative messages, such as stop when you feel better. Until then, public education about antibiotics should highlight the fact that antibiotic resistance is primarily the result of antibiotic overuse and is not prevented by completing a course.’

But Professor Helen Stokes-Lampard, chair of the RCGP, said that ‘we cannot advocate widespread behaviour change on the results of just one study’.

She said: ‘It’s important that patients have clear messages and the mantra to always take the full course of antibiotics is well known – changing this will simply confuse people.

‘We agree with the researchers that more high quality, clinical trials are needed – and when guidelines are updated, they should take all new evidence into account. But we’re not at that stage yet.

‘GPs and our teams are playing a huge part in curbing the trend for overuse of antibiotics, and will prescribe in accordance with clinical guidelines, and act in the best interests of the patient in front of us – we would urge our patients not to change their behaviour based on one study.’

BMJ 2017; available online 26th July


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