Editorials

Should we abandon “finishing the course” of antimicrobials?

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j4170 (Published 22 September 2017) Cite this as: BMJ 2017;358:j4170
  1. Chris Del Mar, professor of public health1,
  2. David F M Looke, infectious disease physician2
  1. 1Bond University, Gold Coast, Australia
  2. 2Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
  1. Correspondence to: C Del Mar cdelmar{at}bond.edu.au

It depends on the type of infection

The recent controversial article in The BMJ1 wasn’t the first commentary to suggest that we should abandon the notion of a course of antibiotics and rethink the whole strategy of duration of therapy for infections.2 The objectives of treatment go beyond “cure” (kill the pathogen) to include reducing symptom severity and duration, the chances of relapse, and transmission to other people. This can be achieved by suppressing the growth of the pathogen until the host immune system destroys it.

How the concept of “the course” evolved is not entirely clear,2 but two strategies probably underlie it. These are to ensure a total adequate dose by spreading a potentially toxic drug over time to avoid high peak levels, and to reduce the chance of resistance evolving within the patient during treatment. We already have information about the duration of treatment needed to get a high probability of cure for some infections. This ranges from a single dose (eg, chlamydia, donovanosis, primary syphilis) through a …

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