To finish or to not finish: New guidelines on medication compliance

To finish or to not finish: New guidelines on medication compliance

Until a few years ago, when giving a prescription for antibiotics, healthcare providers advised us to finish the entire course of medication. Even if you felt better, you were supposed to carry on until the often bitter end.

Even the World Health Organization (WHO) says you should “always complete the full prescription, even if you feel better, because stopping treatment early promotes the growth of drug-resistant bacteria.”

Historically, a full prescription for most infections has been a minimum of seven days and as long as 14. For stubborn infections, a second round of a higher and stronger dose might be given. This approach began in the 1940s.

Recently though, infectious disease experts, educators and physicians are saying we need to rethink this approach, which they say is a habit rather than a sound practice standard.

Let’s take a look at why this way of prescribing antibiotics took root so strongly.

Some medical practitioners believe this started with Alexander Fleming, the discoverer of penicillin. In his 1945 Nobel Prize speech, he said if not enough penicillin was given for an infection, bacteria would develop resistance to the antibiotic.

It turns out that’s not true for all infections or for all forms of bacteria. Tuberculosis, gonorrhea and malaria are all infections with a high risk of producing mutations resulting in antibiotic-resistant bacteria. But generally speaking, most other types of bacteria do not share the same risk.

Does that mean antibiotic resistance isn’t really a concern?

No, antibiotic resistance is a real concern. It just doesn’t work the way we used to think it did. The discovery of penicillin and other antibiotics in the 20th century  radically transformed how we deal with infection. In the United States alone, 150 million prescriptions for antibiotics are ordered every year.

However, it’s become clear that the more antibiotics we use, the more resistance we see. Estimates say two million people a year get antibiotic-resistant infections. Over-prescription and overuse are the real culprits here, not people failing to finish a course of treatment. 

Staying the course, rather than quitting when you feel better, is causing harm rather than preventing it.

That’s because longer courses of antibiotics end up killing all types of bacteria, including the good ones, and this broad-spectrum effect can lead to the development of resistance across the board.  

The bacteria facing the biggest threat of developing resistance are: Escherichia coli, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumonia, Acinetobacter app, Pseudomonas app, and Enterobacter app. We all have these bacteria in our bodies. While they are not harmful, they are carriers for drug-resistant genes. The risk lies in how easily they can swap resistance with other bacteria through a process called conjugation. As a result, drugs lose their power over subsequent generations of bacteria.

What does the research say about drug-resistant antibiotics?

There has been growing concern about antibiotic use for many years, and now there’s new evidence to consider, as published in the British Medical Journal.  The authors had this to say: “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.”

The lead author, Marin Llewellyn, said the team reviewed research which showed that for some infections, like those affecting the ear, a longer course is needed, while for others, like pneumonia, a shorter course is just as effective.

So how are doctors tackling the problem of antibiotic resistance?

First, many doctors have begun to write prescriptions for shorter rounds of drug therapy. They may also advise the patient stop a course of antibiotics early if they are feeling better. This means the patient has to pay attention to how they’re feeling at the start so they can make a good assessment of their response to the medication.

Second, if patients keep coming back with repeat infections, doctors are beginning to look at what lifestyle changes the patient can make, what environmental factors are at play, and what approaches, including prescription management, need to be considered.

Never stop a course of medication unless you have discussed it with your healthcare provider. But remember, you can express your concerns about antibiotic resistance to your doctor or pharmacist, just as you can ask them about anything else you should be aware of when taking medications.