THERE are few topics in medicine which cause quite as much heated debate as that of antibiotics, which again hit the headlines recently, when a group of renowned specialists proposed that the idea of completing the full course was outdated, based on little evidence, and indeed may even be one of the causes of antibiotic resistance.

With 12,000 deaths due to antibiotic-resistant bugs every year, shockingly, these account for more fatalities than breast cancer.

The group of infectious diseases experts at Brighton and Sussex Medical School, led by Professor Martin Llewelyn, examined a group of patients in hospital requiring antibiotics, and came to the conclusion that it was safe to stop some antibiotics before the recommended duration, based on improvement in the patients’ condition.

Loading article content

Unfortunately rather than provide clarity on the situation, I feel this may have only caused further confusion, at a time when healthcare messages need to be easy to understand, definite and not open to interpretation.

The study was based on a limited number of patients, with a small range of illnesses, who were in hospital, and hence could be monitored on a daily basis. This included regular review of markers of improvement including blood tests and temperature measurements; hence it would have been easy to ascertain objectively when patients were getting better. The majority of antibiotics prescriptions are made outside of the hospital setting, where this level of monitoring is not available.

The advice to finish your antibiotic when you feel better is very subjective. Within 24 to 48 hours of starting treatment you are likely to have improved, provided you are on the correct antibiotic.

This is accounted for by a large number of bacteria being killed in this time. However, those left will be by nature resistant, and stopping at such an early point not only allows them to thrive, but may even increase their resistance. If you stop antibiotics and find that you again feel unwell a few days later, the antibiotic may well have no effect at all.

Respected authorities including the Chair of the Royal College of General Practitioners, Professor Helen Stokes-Lampard, the Chief Medical Officer, Dame Sally Davies and the World Health Organisation have unanimously agreed that evidence for stopping antibiotics when you feel better is lacking at the present time, and that you should complete the full course.

The length of a prescription is not a random duration, and has been advised based upon a large amount of robust research. In addition some antibiotic treatments are already short, for example just three days for a simple urinary tract infection.

I feel that the issue of antibiotic resistance is more related to patient perception of need for antibiotics as well as doctors prescribing in situations where there may not be an obvious requirement. We know that viral infections, for example the common cold or sore throats, although often painful, do not need antibiotics, and are better managed with simple painkillers. Even some mild bacterial infections will resolve on their own, with a study demonstrating that half of urinary tract infections in otherwise healthy individuals would clear in three days with only ibuprofen and drinking more water. Antibiotics themselves are not risk free, with skin irritation, rashes and diarrhoea as commonly reported side effects.

The point to remember is that it is the bacteria, not us as individuals who become resistant. There are now some organisms resistant to every available antibiotic, with patients sadly dying as a result. A massive rise in antibiotic resistance could result in a situation where surgical treatments including bowel operations and joint replacements, which need antibiotic cover, could not be performed.

In conclusion, the advice remains hopefully simple. If you are prescribed antibiotics, please complete the full course. If after listening to your symptoms and examining you, your doctor feels you do not need antibiotics, please listen to their advice. However, if you are not improving within an agreed time frame, it is worth seeking their advice again. The problem of antibiotic resistance is one that doctors and patients need to tackle together to benefit the individual as well as society.

Dr Zak Uddin, @AskDoctorZak