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28 Jul 2017

Full course antibiotics ' harmful'...Drug mantra is not backed by evidence, can increase drug resistance: Doctors

KAT LAY, TT, July 27: It is a mantra followed by patients across Britain: always complete the full course of antibiotics even if the ailment is long forgotten.
Now specialists have warned that such advice is not backed by evidence, and could be increasing drug resistance.
Doctors could instead tell patients to stop taking medication when they feel better, experts write in The BMJ today.
Martin Llewelyn, of Brighton and Sussex Medical School, and nine colleagues from universities across the country urge health officials and school biology teachers to " stop advocating ' complete the course'" and " publicly and actively state that this was not evidence- based and is incorrect". GP leaders voiced concern that changing the simple message could cause confusion, however, and urged patients to keep following the advice.
Family doctors prescribed about 34 million courses of antibiotics in 2015- 16.
They treat conditions such as severe acne, kidney infections and pneumonia, especially among the elderly, but many patients stop their courses early, despite the warnings that under- treated bacteria will turn resistant.
Up to 50,000 people are estimated to die each year in Europe and the US from antibiotic- resistant infections.
In the BMJ article, the infection experts warn that the length of most antibiotic courses — typically three to ten days — is not based on good clinical studies, meaning that patients may be taking them for longer than they need to.
This raises the risk of antibiotic resistance and goes against the principle that people should take as little medication as necessary.
Tim Peto, professor of medicine at the University of Oxford and one of the authors, said: " If we compare it with something like heart disease, there is a huge evidence basis for treatment... but for the use of antibiotics, duration of treatment, there is very little evidence. We want to improve prescribing — for doctors to take a personalised view on when they should tell a person to stop." The researchers called for studies into alternative messages, such as " stop when you feel better". Jodi Lindsay, professor of microbial pathogenesis at St George's, University of London, said: " Evidence for ' completing the course' is poor, and the length of the course of antibiotics has been estimated based on a fear of undertreating rather than any studies." Antibiotic resistance is a growing threat. Dame Sally Davies, the chief medical officer, has warned that society faces an " apocalyptic" scenario in which common infections are fatal and treatments from hip replacements to chemotherapy become impossible.
Helen Stokes- Lampard, chairwoman of the Royal College of GPs, said: " We are concerned about the concept of patients stopping taking their medication... once they ' feel better', because improvement in symptoms does not necessarily mean the infection has been eradicated... The mantra to always take the full course of antibiotics is well known — changing this will simply confuse people." THE TIMES, LONDON PERSONALISED VIEW

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