Warnings given to patients at the start of treatment to “complete the course” of antibiotics is not supported by evidence, according to an article in a leading medical journal.
But a Maltese expert told the Times of Malta that while in line with current trends in antibiotic research, the study should not encourage patients to take their treatment into their own hands.
Writing in the British Medical Journal, Professor Martin Llewelyn at Brighton and Sussex Medical School and colleagues said that patients are put at unnecessary risk from antibiotic resistance when treatment is given for longer than necessary, not when it is stopped early.
The experts said that traditionally antibiotics are prescribed for recommended treatment courses and fundamental to this concept is the notion that a shorter treatment would be more inferior.
They added that for most indications, studies to identify the minimum effective treatment duration simply have not been performed.
The “complete the course” notion ignored the fact that different patients respond to treatments in different ways, they said, adding: “Currently, we largely ignore this fact and instead make indication specific recommendations for antibiotic duration that are based on poor evidence.
“This situation is changing in hospital practice, where biomarkers of treatment response can guide when to stop antibiotic treatment.
“Outside hospital, where repeated testing may not be feasible, patients might be best advised to stop treatment when they feel better, in direct contradiction of WHO (World Health Organisation) advice.”
Commenting on the study, Professor Michael Borg, head of the Malta National Antibiotic Committee, said many of the treatment durations used today were based on studies carried out as long as 30 years ago, when available antibiotics were far less sophisticated.
Over the last decade, he said, there had been an increased emphasis on new research to establish whether those durations were still valid today, with many courses being reduced as a result.
“It may very well that with this study we will see shorter and shorter courses of treatment recommended for different infections,” Prof. Borg said.
“But we can only follow current guidance, and patients should not stop antibiotics because they are feeling better. The impact of this study is not on patients, but follows the current trend.”
Prof. Borg said awareness had been growing on how antibiotic use could drive microbial resistance, potentially reducing the effectiveness of the treatment of dangerous diseases.
“What matters is the total amount of antibiotic use, so if we can safely give shorter courses of antibiotics, this would be of major benefit because the total antibiotic use would be much lower,” he said.
Several studies have shown that antibiotic resistance in Malta is among the highest in Europe.
According to statistics published by the European Centre for Disease Control ESAC-Net network, community consumption of antibiotics in Malta has increased by 30 per cent since 2007; with more than 80 per cent originating from private GP prescriptions.
Recent local studies correlated with a 2013 Eurobarometer report showing that more than 70 per cent of antibiotics were prescribed for flu, colds and sore throat; all primarily viral infections for which antibiotics are ineffective.
With additional reporting by the Press Association.