Full antibiotic course ‘unnecessary’ - study
NOAH says animal keepers should continue to follow their vet's advice about using antibiotics.
The time has come to drop the message that patients must always complete a course of antibiotics, according to experts in the British Medical Journal (BMJ).
Writing in an Analysis article, the authors argue there is little evidence to support the idea that stopping antibiotic treatment early encourages antibiotic resistance. In contrast, they claim that patients are put at unnecessary risk from antibiotic resistance when treatment is given for longer than necessary.
‘Research is needed to determine the most appropriate simple alternative message, such as stop when you feel better,’ they write.
‘Until then, public education about antibiotics should highlight the fact that antibiotic resistance is primarily the result of antibiotic overuse and is not prevented by completing a course. The public should be encouraged to recognise that antibiotics are a precious and finite natural resource that should be conserved.’
But the National Office of Animal Health (NOAH) says that animal keepers should continue to follow their vet’s advice about using antibiotics.
“Our advice is always to follow the instructions of the prescribing vet – as to whether antibiotics are needed at all, or if they are prescribed, to complete the prescribed course,” said a NOAH spokesperson.
“Outside of a hospital situation where there is daily monitoring, it is not practical for a farmer or a pet owner to make a subjective judgement on whether the symptoms have improved and treatment should stop, and any confusion over this could leave the door open for resistant bacteria to potentially proliferate.”
BVA junior vice president John Fishwick said that, until further studies are conducted, it is too early to change the way medicines are prescribed.
“Vets should continue to prescribe as previously, only when necessary,” he said. “It is also vital that clients continue to follow the directions given by their vets, both in terms of dosage and duration of treatment, carefully.”
He adds: “The article in the BMJ suggests that antibiotics should be used for as short a period as possible, and that we should move away from the concept of following a predetermined course. This may indeed be a very important advance but it is far too early to determine how this would work in veterinary practice. We need to clearly establish the evidence supporting it.”
Compiled by a collaborative group of experts, the BMJ article states that reducing unnecessary antibiotic use is ‘essential’ to combat the growing problem of antibiotic resistance.
Together with colleagues, Professor Martin Llewelyn, from the Brighton and Sussex Medical School, asserts the idea that ending antibiotic treatment early encourages the growth of drug resistant bacteria.
He notes that, historically, antibiotic courses were ‘set by precedent, driven by fear of under treatment, with less concern about overuse’. Today, however, there is growing evidence to suggest that shorter durations may be just as effective.
‘Shorter duration of treatment has been shown to reduce clinical efficacy in a few cases,’ he writes. ‘A notable example is otitis media, where five days’ treatment is associated with a lower clinical cure rate (66%) than 10 days (84%) in children under 2 years.’
The authors conclude that clinical trials are needed to ascertain the most effective strategies for optimising duration of antibiotic treatment.
RCVS Knowledge has welcomed Professor Peter Cockcroft as editor-in-chief for Veterinary Evidence. 
