To complete or not? Antibiotic Research UK responds to paper on the antibiotic course

An analysis piece recently published in the British Medical Journal (BMJ) has claimed that we should reconsider the adage of always completing a course of antibiotic treatment even if you feel better prior to completion in order to help combat antibiotic resistance.

The paper, authored by Professor Martin Llewelyn and colleagues from the Brighton and Sussex Medical School, specifies that there is little evidence to demonstrate that not completing a course of antibiotics contributes to antibiotic resistance. However, the authors state that there is evidence that, in some cases, stopping antibiotics before the course is set to end is ‘a safe and effective way to reduce antibiotic overuse’.

In response to the publication of this paper, Professor Colin Garner, chief executive of Antibiotic Research UK, commented: “Whilst one can see sound scientific reasons to reduce antibiotic treatment periods, there is little scientific evidence to support this conclusion.

The authors of the BMJ paper cite just seven studies where antibiotic treatment periods have been examined. Evidence based medicine tells us that we should only alter how long antibiotics should be given for as a result of well conducted clinical trials.

If this paper stimulates clinical researchers to embark on such trials then the authors will have made a valuable contribution. On the other hand, from the patient’s perspective, would they be happy to be enrolled in a trial where the outcome of a shorter antibiotic treatment period might result in their infection not being successfully treated?

Antibiotics are not the only drugs where the treatment period is not backed up by sound science. The same questions might be asked for certain cancer treatments, for example. The length of recommended drug treatment is usually determined by the dose and duration that was used in the clinical trials to support the registration of that drug. If we want to deviate from these recommendations we should only do so with supporting clinical trial data. My concern is that the authors message could confuse patients and I would strongly recommend therefore that patients follow the advice of their doctor.”

Antibiotic Research UK (ANTRUK) is a national charity dedicated to finding new antibiotics against resistant bacteria. ANTRUK aims to raise sufficient funds over the next five years to bring at least one new antibiotic therapy to market by the early 2020’s.