Can you shorten an antibiotics course?
The news about antibiotic resistance can be scary. In February 2017, for the first time ever, the World Health Organization released a list of the world’s 12 most dangerous superbugs. The move was intended to promote research and development of new antibiotics, a field that has been lagging for years.
Antibiotic resistant bacteria like Methicillin-resistance Staphylococcus aureus (better known as MRSA) are known to be a grave threat, but even diseases like gonorrhea, which have long been successfully treated with antibiotics, are developing resistance to the commonly used drugs.
Fears over this issue prompted a group of practicing physicians to publish an opinion piece in The BMJ arguing that doctors should stop telling patients to finish all antibiotic prescriptions because antibiotic overuse may be contributing to the resistance problem. It was a controversial stance with which many who work in healthcare quality, like Kevin Mulroy, DO, chief quality officer for Cape Cod Healthcare, do not agree.
“We try not to do anything that’s not evidence based,” he said. “I would get really nervous about following the recommendation in that article and leaving it up to symptoms. Just because you’re feeling better doesn’t mean that you’ve eradicated the bacteria that you’re trying to get with the antibiotic.”
At this time there is no proven evidence that the current dosage guidelines are creating resistance, Dr. Mulroy said, adding that he believes it is a topic that deserves more research. What worries him more are people being readmitted to the hospital for the same illness because they took a shorter course of antibiotics than recommended.
“Cycling through antibiotics frequently – that causes resistance,” he said. “Introducing and reintroducing antibiotics is something that is much more dangerous. When you eradicate something, you want to eradicate it fully.”
Don’t Work On Viruses
Using antibiotics when they are not indicated is also dangerous, Dr. Mulroy said. Antibiotics only work on bacteria. People with illnesses like bronchitis, sinusitis or the flu usually don’t need an antibiotic.
“You want to know exactly what you are treating,” he said. “The way to keep resistance patterns down is to not use antibiotics when they are not needed.”
If your doctor says your illness is probably viral and an antibiotic won’t help, it’s a good idea to listen. Despite the fact that you don’t feel well, the illness will get better on its own. If it doesn’t go away in 72 hours or you develop a high fever, call your doctor back to re-evaluate.
Dr. Mulroy keeps an eye on all the research about superbugs, but said they haven’t been a significant problem on Cape Cod. One of the ways that Cape Cod Healthcare physicians help keep antibiotic resistance down is with a judicious choice of when and what to prescribe.
“Using the latest and greatest antibiotic isn’t always the best way to go,” he said. “You want to use the tried and true antibiotics first, if you can. And then we save the big guns for later. We want to hold onto the latest antibiotics to use them when nothing else works.”
Overuse of antibiotics in food, not patients, is probably the biggest factor in the new resistance patterns, Dr. Mulroy said. The Food and Drug Administration estimates that 80 percent of all antibiotics used in the United States are fed to farm animals. Farmers use the antibiotics to promote faster growth and to compensate for the unsanitary conditions in which the animals are raised.
It has become such a rising concern that in January the FDA issued a voluntary ban for producers of livestock to not use antibiotics or antimicrobial drugs that have been deemed medically important to people. In the past antibiotics and antimicrobials were put right in the animal’s food. In an effort to provide more oversight, the FDA policy also requires supervision by a veterinarian before food animals can be given medically important drugs.
“Using antibiotics where they don’t belong is a good way to turn good bacteria into bad bacteria,” Dr. Mulroy said. “It puts pressure on the bacteria to evolve or die. Through natural selection some bacteria will develop a mutation that causes it to be resistant and then that bacteria will grow and flourish.”
He concluded that the overuse and inappropriate use of antibiotics is what causes resistance, not the duration. With that in mind, he recommends following the current guidelines.
“Until there’s evidence that a shorter course of antibiotics doesn’t cause harm and doesn’t cause relapse, I would stick with what we have right now,” he said. “Finish your antibiotics.”