Why the advice to take all your antibiotics may be wrong

Why the advice to take all your antibiotics may be wrong – Stat News By Helen Branswell @HelenBranswell – February 9, 2017

If you’re taking antibiotics, don’t stop taking them until the pill vial is empty, even if you feel better. But the warning, a growing number of experts say, is misguided and may actually be exacerbating antibiotic resistance.

The reasoning is simple:

  • Exposure to antibiotics is what drives bacteria to develop resistance.
  • Taking drugs when you aren’t sick anymore simply gives the hordes of bacteria in and on your body more incentive to evolve to evade the drugs, so the next time you have an infection, they may not work.

The traditional reasoning from doctors “never made any sense. It doesn’t make any sense today,” Dr. Louis Rice, chairman of the department of medicine at the Warren Alpert Medical School at Brown University, told STAT.

No one is doubting the lifesaving importance of antibiotics. They kill bacteria.

But the more the bugs are exposed to the drugs, the more survival tricks the bacteria acquire. And the more resistant the bacteria become, the harder they are to treat.

There’s little incentive for pharmaceutical companies to conduct expensive studies aimed at finding the shortest duration of treatment for various conditions.

But in the years since Rice first raised his concerns, the National Institutes of Health has been funding such research and almost invariably the ensuing studies have found that many infections can be cured more quickly than had been thought.

Treatments that were once two weeks have been cut to one, 10 days have been reduced to seven and so on.

“I’m not here saying that every infection can be treated for two days or three days.

I’m just saying: Let’s figure it out.”

In the meantime, doctors and public health agencies are in a quandary. How do you put the new thinking into practice? And how do you advise the public?

Doctors know full well some portion of people unilaterally decide to stop taking their antibiotics because they feel better.

But that approach is not safe in all circumstances — for instance tuberculosis or bone infections. And it’s not an approach many physicians feel comfortable endorsing.

CDC’S Get Smart campaign, on appropriate antibiotic use, urges people never to skip doses or stop the drugs because they’re feeling better.

The CDC gets stuck in myths of the past all the time, especially when they are fortified by financially interested parties, like the pharmaceutical industry in the case of antibiotics and like PROP in the case of opioids.

But Hicks noted the CDC recently revised it to add “unless your healthcare professional tells you to do so” to that advice.

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