Is it time to stop counselling patients to “finish the course of antibiotics”?
ncbi.nlm.nih.gov
ncbi.nlm.nih.gov
As support they cite that some infections can be reliably cured with shorter courses of antibiotics than the standard course. (they list 3 diseases that can be effectively treated with shorter courses, and 2 that cannot)
Assuming that this is true, the correct response is to prescribe shorter courses of antibiotics for diseases where that is indicated, NOT to stop telling patients that they need to finish the prescription.
Speaking as an ex-microbiologist.
Quite an unclear statement and the article as a whole. Article explains well why "finish the course" could be the right thing - Fleming's Nobel lecture is brought as illustration - but then fails explaining how and why this "finishing" is wrong.
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I always wondered about this, but I accepted explanations to the contrary (which IIRC were something like "keeping the overall population of bacteria low so a recurrence of the infection, now with a larger portion of resistant bacteria, wouldn't give the opportunity for the resistant bacteria to spread")
It always seemed like a pseudoscience explanation, but things can be complicated at the highly detailed level, so I assumed there were more complicated mechanisms / statistics / science that underlay the "take the whole course".
Alas the media will probably do a bunch of sensationalist "the scientists don't know anything" stories typical of American anti-intellectualism.
I've never understood why a longer course of antibiotics would kill a resistant bacteria, while a shorter one won't. It's either resistant or it's not.
Bacteria multiply far far too fast for them to notice multi-day courses of treatment, a bacteria only "notices" the current conditions before it either multiplies or dies.
By prolonging medication you wipe out all the susceptible bacteria leaving only the resistant ones. It seems to me that instead we should use just enough antibiotic to keep the patient alive (to turn the corner) and then let the patients immune system do the rest.
If I'm wrong about any of the above, I would love responses explaining why.
https://litfl.com/minimum-inhibitory-concentration/
It’s more of a spectrum of concentrations. A resistant bacteria is one that doesn’t grow above a certain threshold. But longer exposure or higher concentration will change the effectiveness.
Resistance is not a binary thing. Often it simply means that a population of "resistant" bacteria takes longer to be completely eliminated, not that they are completely unaffected.
It would be better if a different term were used to describe bacteria that are completely unaffected by a given antibiotic; perhaps "invulnerable" would do. If you are in fact dealing with bacteria that are invulnerable to a particular antibiotic, then you need to switch antibiotics, yes.
> Bacteria multiply far far too fast for them to notice multi-day courses of treatment
Bacteria multiply far too fast under ideal conditions. But the whole point of giving an antibiotic is to make the conditions as far as possible from ideal.
> a bacteria only "notices" the current conditions before it either multiplies or dies
Bacteria are not mayflies. They don't have to either multiply or die within a short period of time.
> It seems to me that instead we should use just enough antibiotic to keep the patient alive (to turn the corner) and then let the patients immune system do the rest.
Antibiotics suppress the patient's immune system, so once you have started them, you need to finish the job with them.
If you are going to try to let the patient's immune system fight the infection, then I would think you would not give antibiotics at all; instead you would focus on maximizing supportive care for the patient's immune system (for example, they probably need to eat a lot of protein since the immune system needs protein to make antibodies, T-cells, etc.), and for the patient generally (make sure they stay hydrated, etc.).
The thing you're missing is that bacteria share genes. So if you have a high proportion of resistant bacteria, but non-resistant bacteria are still around, the genes survive and spread. But if only the (few) resistant ones are around, the (weakened) immune system can kill them and the genes don't.
(And also, “it's either resistant or it's not” is an oversimplification in many real-world cases.)
[0] https://bmcmedicine.biomedcentral.com/submission-guidelines/...
The article makes the case for prescribing shorter courses of antibiotics for some infections, and they're probably right. You would need to show there is more harm from obeying doctor's orders before you write an absurd headline like this that leads people to second-guess medical advice for little good.
[1] https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headline...
> The time has come to challenge the maxim “finish the course.”
The article says more research is needed, but suggests patients, perhaps in consultation with their doctors, should discontinue use when they feel better.
> The time has come to challenge the maxim “finish the course.”
The fact that the article claims that it has made a case for not telling patients to finish the course does not mean that claim is correct. It isn't.
> The article says more research is needed, but suggests patients, perhaps in consultation with their doctors, should discontinue use when they feel better.
And, as others have already pointed out upthread, this suggestion is not justified by the research discussed in the article. What is justified by that research is prescribing shorter courses of certain antibiotics when a shorter course has been shown to be sufficient for those particular antibiotics for the particular infection being treated. But that is not at all an argument for not telling the patient to finish the course that has been prescribed. In fact it's an argument against it, since the whole point of prescribing a specific course for a specific time is that that is the time that has been scientifically shown to be sufficient. Stopping the prescribed course early just because you feel better, even if it's in consultation with the doctor, goes against the actual science. What the actual science says is to take the specific circumstances into account when prescribing a course of antibiotics in the first place.
Yes, it does conclude with that statement. However, little in the article supports the notion that patients should be second guessing medical doctors. Rather, the article provides some evidence that current dosing is wrong and shorter courses would be better.
It’s 2020 and we have a lot of tools to track users across the Internet but we don’t have anything besides blood tests to figure out our health. It definitely seems like an industry ripe for disruption.
For example, if you want Ursodiol for your gallstones, you will have to fight with your doctor. Why? You have to take it--daily, reliably, for more than a year before you will see any improvement. Yes, you may be an engineer with the self-discipline and knowledge to understand that you are basically ungrowing a crystal and that's a slow process, but the majority are not. They will miss treatments, they will double up treatments (useless, in this case), they will get tired of side effects, etc.
> we don’t have anything besides blood tests to figure out our health. It definitely seems like an industry ripe for disruption.
Spoken like an arrogant techie.
A blood test doesn't magically indicate what is wrong with you, and there is a lot of noise in the signal where a blood test indicates something is wrong that really isn't.