The antibiotic course has had its day

BMJ 2017; 358 doi: (Published 26 July 2017) Cite this as: BMJ 2017;358:j3418

Re: The antibiotic course has had its day

I read the article “The antibiotic course has had its day” [1] written by Llewelyn and colleagues with great interest. The article raises debate on a very sensitive topic of the current era.

I agree with authors that antibiotic resistance is a global threat and there is no strong evidence to show that failing to complete a given course contributes to antibiotic resistance. However, the conclusion that the antibiotic course has had its day cannot be made as of now. This is just one paper and author’s opinion without very strong evidence (e.g. from a meta-analysis which is considered highest level of evidence). As the method of analysis and statistical basis of conclusion is not reported in the article, in my view, the article might be considered as “Opinion and views” rather than “Analysis”. Overall it looks like opinion of authors supported by some published articles.

Clinicians are the best judge for their patient and may use antibiotics as per their discretion based on the patient’s condition and response, guidelines or as per the prescribing information of the particular product. My fear is that patients may discontinue antibiotics on their own, or take “as and when required”, reading the article. Moreover, there are chances of misinterpreting the article. For example, one of the articles reported findings as “…. study says” [2]. when it is not a study. Adding a line of caution for the patient would serve to avoid misuse of antibiotics by patients on their own without consulting their treating physician.

Although the article is a great effort by authors towards finding possible solution to overcome resistance, the conclusion needs to be carefully extrapolated especially by the patients and general population.

1. Llewelyn MJ, Fitzpatrick JM, Darwin E, Tonkin-Crine S, Gorton C, Paul J, et al. The antibiotic course has had its day BMJ 2017; 358 doi:
2. Rule that patients must finish antibiotics course is wrong, study says available at accessed on 31st July 2017

Competing interests: No competing interests

31 July 2017
Anant Patil
Asst Professor, Department of Pharmacology
Bharti Vidyapeeth Deemed University Dental College
Navi Mumbai, India
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