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Taking a course of antibiotics for too long could be a bigger problem than not taking it long enough:
It is time to reconsider the widespread advice that people should always complete an entire course of antibiotics, experts in the BMJ say.
They argue there is not enough evidence to back the idea that stopping pills early encourages antibiotic resistance.
Instead, they suggest, more studies need to be done to see if other strategies - such as stopping once feeling better - can help cut antibiotic use.
But GPs urge people not to change their behaviour in the face of one study.
[...] The opinion piece, by a team of researchers from across England, argues that reducing the use of antibiotics is essential to help combat the growing problem of antibiotic resistance.
Prof Martin Llewelyn, from the Brighton and Sussex Medical School, together with colleagues, argues that using antibiotics for longer than necessary can increase the risk of resistance.
He suggests traditional long prescriptions for antibiotics were based on the outdated idea that resistance to an antibiotic could develop when a drug was not taken for a lengthy time and an infection was undertreated.
Instead, he says, there is now growing evidence that short courses of antibiotics - lasting three to five days, for example - work just as well to treat many bugs.
Also at Scientific American and Newsweek.
The antibiotic course has had its day (open, DOI: 10.1136/bmj.j3418) (DX)
(Score: 4, Informative) by vux984 on Friday July 28 2017, @01:28AM (5 children)
The so-called 'outdated idea' is natural selection. The idea being that short antibiotic courses would kill off all the bacteria that were not resistant, leaving those that were resistant behind, to repopulate after the course was complete. The repopulation of course, would be a lot more resistant.
The long course, was designed to wipe out even the 'resistant bacteria' (the premise being that is resistant, not immune, so it too will die with the longer course). Any reinfection will simply be a 'new infection' and not a re-polulation descended from the suriving resistant bacteria; and now much more resistant population as a whole.
There is a logic to it.
Sure. If there were no resistant bacteria and the antibiotic course eliminates the infection in just a few days, then doing it longer isn't going to kill any more bacteria (and usually just causes more side effects in the victim). Its almost self evident that most of the time, a short course is sufficient. Kill enough, let the bodies immune system do the rest... infection dealt with. No need for more.
And its also possible that the longer courses are breeding superbugs *faster*, with the increased selection pressure; only the hardiest bacteria survive. In which case shorter courses that stop sooner put less selection pressure on the bacteria, and lead to superbugs taking longer to evolve, or possibly keep them from evolving.
So there is a logic to that too.
I definitely support studying it, to find the optimal course treatment lengths (likely a function of the infection type, patient condition, etc... )
(Score: 3, Interesting) by Immerman on Friday July 28 2017, @02:10AM (2 children)
There's also the fact that evolution potentially works considerably differently in bacteria than in "higher" organisms, since they engage in horizontal gene transfer. A healthy person is loaded with symbiotic bacteria that get just as hammered by broad-spectrum antibiotics - except they don't really have to contend with the immune system in the same way. So while antibiotics may (nearly) wipe out an infection so that your immune system can sweep up the stragglers, the resistant symbiotes though repopulate, and may engage in gene transfer with the next infection that passes through.
As an aside, I've been curious as to whether bacteria demonstrate any "intent" with gene transfer - i.e. is the process random, or are useful genes more likely to be transferred?
(Score: 0) by Anonymous Coward on Friday July 28 2017, @05:54AM (1 child)
Sorry to sound trite but "yes"
(Score: 0) by Anonymous Coward on Friday July 28 2017, @08:56AM
Sorry, let me rephrase that: are useful genes more likely to be transferred?
(Score: 0) by Anonymous Coward on Friday July 28 2017, @03:33AM
The ultimate solution is to stop using antibiotics for most infections. There's a relatively small number of bacteria that really warrant the antibiotics. In most cases, you're better off either crowding them out with helpful/benign strains or targeting them for death via phages. This whole business of using antibiotics that fuck up your immune system is something that really needs to go before it kills us all.
(Score: 2) by darkfeline on Saturday July 29 2017, @03:28AM
I think that logic is flawed. You're not going to kill 100% of any bacteria in your body unless you vaporize every cell in your body too.
Instead, what happens is that a long course of antibiotics are going to leave the 99% resistant bacteria to repopulate, vs a short course of antibiotics leaving ~50% resistant bacteria. The antibiotic resistance will not be as strongly selected for in the short course, whereas the long course will strongly select for strongly resistant bacteria.
Unless your own immune system is completely shot, natural selection logic would suggest that you don't take too much antibiotics to reduce the amount of natural selection going on.
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