Saturday, 12 August 2017

"Don't complete your course of antibiotics!" (BMJ)

    That is the advice of an article recently published in the prestigious British Medical Journal.  In an article entitled "The antibiotic course has had its day." by Dr. Martin LLewelyn et al. it is suggested that continuing the course of antibiotics for the recommended time is not only unnecessary but is actually harmful, in that it promotes the emergence of resistant strains and also that it is more likely to cause side-effects.  Funny, because the rationale used to be if you DIDN'T finish your course of antibiotics that you promoted resistance by allowing resistant mutations to supervene.    Both the CDC and Public Health England in their public health information recommend taking the medicine "exactly as prescribed", whereas previously they had recommended "completing the course".  So they are both sitting on the fence. The article even goes so far as to recommend that the patient be advised to stop the antibiotic when they feel better - a dangerous recommendation, especially if they are not under close medical supervision.
   Fifty five years in the trenches as a general practitioner have convinced me that it is essential to prescribe a course of antibiotic treatment that is clearly defined, based on the best current knowledge and on the experience of the practitioner.  Notwithstanding the fact that experience is much derogated in this age when everyone wants to feel their opinion is equal, it has no substitute.  Years of study, observation and practice in the field does confer on the practitioner a level of expertise that is not generally shared by the public or even by many medical specialists.  I suspect that the sort of specialist practice that Dr. Llewellyn follows does not include seeing large numbers of patients of all ages, body types, gender and ethnicities and their response to antibiotic treatment.  I suspect that he has no experience of the recurrences of symptoms and repeat visits generated by early discontinuation of treatment and I suspect that most of his data has been dragged out of computer databases or dusty charts.  His conclusions are based on dataism and statistics, mine are based on patient observation.  I think there is at least as much objective evidence to support the importance of completing the course even if one totally disregards actual experience in the field.
Please comment if you have any views on this.

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