We Can’t Make Blanket Rules About Finishing Antibiotic Prescriptions

Finishing a full course of antibiotics could do more harm than good, according to the authors of an editorial published last week in the BMJ.

Traditionally, people prescribed antibiotics for all types of infections would be told by their doctors to take every pill in the bottle. The World Health Organization told patients in a 2016 campaign to "always complete the full prescription, even if you feel better, because stopping treatment early promotes the growth of drug-resistant bacteria."

Recently, scientists have begun to challenge that notion: Tonic covered it back in February, but the pushback has been simmering for years. Now it's gaining even more steam. "The idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence, while taking antibiotics for longer than necessary increases the risk of resistance," write the authors in the BMJ editorial. They argue that overuse of antibiotics is the bigger problem and encourage policy makers, educators, and doctors to stop telling people to "complete the course."

That's a 180 from the advice most people have heard all their lives. Studies have shown that three to five days' worth of antibiotics are just as effective as longer courses that can last a week or more. Instead of killing off the disease-causing bacteria more thoroughly, longer courses of antibiotics may increase the amount of time the strongest bacteria are exposed to the compounds intended to kill them, which could give them more opportunity to develop mutations that allow them to survive.

The million-dollar-question is: how long should someone take antibiotics in order to get better but not breed super bacteria? For now, there's no consistent answer. The editorial's authors argue that broad guidelines to finish a course aren't supported by evidence and they advocate for patients to stop taking the drugs once they start feeling better. But critics told GIzmodo this guideline is too vague and isn't supported by science, either.

One doctor told Gizmodo that the BMJ authors ignore some facts, such as a 2016 study published in the New England Journal of Medicine which showed that bacteria that causes ear infections in children did not, in fact, develop more resistance when treated with a longer course of antibiotics. Another called the editorial "hazardous" for encouraging patients to defy physicians' advice, especially since some types of infections, such as tuberculosis, have already become so resistant to treatment that patients must take the whole course to vanquish the disease. Plus, if people have unfinished bottles of antibiotics at home, they might be tempted to take them the next time they're sick without consulting a doctor.

Clearly, generalized rules about how long everyone should take every type of antibiotic aren't cutting it. But to figure out how those rules should be updated, and about what length of antibiotic course works best for which conditions, scientists agree that they need more data. With any luck, the controversy sparked by the BMJ article could inspire scientists to conduct some of that much-needed research. In the meantime, do as your doctor says.

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