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 do perfectly agree with the authors that the conventional argument of “completing the course of antibiotic “ to prevent development of antibiotic resistance is not based on scientific evidence. There is no disagreement among experts that, as far as antibiotic resistance potential is concerned, a shorter course is safer than a longer one. There is more and more evidence in the recent literature for shorter course of antibiotics for many infections and expert guidelines are already recommending shorter courses wherever and whenever published good quality evidences for shorter courses are available.

Unfortunately the BMJ article has presented this already well known truth as an out of the box revolutionary idea. It is so unfortunate but not at all unexpected that journalists from around the world, in a short span of one week since publication of the article, have written highly misleading articles conveying the dangerous idea that patients “can stop their antibiotics when they feel better”. There is no evidence that the infection will be cured and will not relapse if antibiotic are stopped when patient feels better. We need research to prove safety of the “patient feels better” approach. Until researchers produce good quality evidence for the safety of “stop antibiotics when you feel better approach” for all common types of infections, in various groups of patients, ranging from small children to elderly and immunocompromised; patients must follow the prescription of their doctors “exactly as advised”.

It is true that controversial articles create widespread discussion on important issues. Unfortunately this article has probably done more harm than good to the field of antibiotic stewardship. This article is based on concrete facts, but written in a highly misleading way and interpreted by media and the public in a dangerously erroneous style.

Competing interests: No competing interests

02 August 2017
Consultant in Infectious diseases
Apollo Cancer Institute, Chennai