Advice to "Complete the Course" of Most Antibiotics Seen as Unfounded

By Joe Elia

Edited by Susan Sadoughi, MD

The "deeply embedded" view that failing to complete a course of antibiotics will lead to drug resistance has no evidentiary basis, according to an analysis in The BMJ.

The authors cite exhortations from the World Health Organization (and similar advice from the CDC) to "always complete the full prescription" as unfounded, and observe that studies on the best duration of most antibiotic therapies simply haven't been done. They write: "Patients might be best advised to stop treatment when they feel better."

To support their argument, the authors cite trials — for example, in streptococcal pharyngitis and community-acquired pneumonia — in which shortened courses were noninferior to longer, standard treatments. (However, they also cite the need to complete full-course therapy in otitis media, where research has shown the advantage of doing so.)

The public should understand, they say, that resistance results from overuse "and is not prevented by completing a course."