Doctors must stop telling patients to finish an entire course of antibiotics because it is driving antimicrobial resistance,and patients should be encouraged to continue taking medication only until they feel better to avoid the overuse of drugs,experts from bodies including Pubtic Health England and the University of Oxford are now advising.Current guidance from the NHS and the World Health Organisation says it is essential to'finish a course'of antibiotics to avoid triggering more virulent forms of disease.But in a new article in the British Medical Journal（BMJ）,10 leading experts said the public health message is not backed by evidence and should be dropped.They claim it actually puts the public at greater risk from antimicrobial resistance."Historically,antibiotic courses were driven by fear of undertreatment,with less concern about overuse,"said lead author Martin Llewelyn,professor of infectious diseases at Brighton and Sussex Medical School."The idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence,while taking antibiotics for longer than necessary increases the risk of resistance.We encourage policy makers,educators,and doctors to stop advocating'complete the course'when communicating with the public."Fears that stopping antibiotics early could trigger more dangerous forms of disease date back to Alexander Fleming who found that bacteria quickly become~acclimatised to penicillin and patients who take insufficient doses may transmit a more dangerous strain to family members.In his Nobel Prize acceptance speech in 1945,Fleming warned:"If you use penicillin,use enough."But in the BMJ article the experts argue that when a patient takes any antibiotics it allows dangerous strains of bacteria to grow on the skin and gut which could cause problems later.The longer the course,the more the resistance builds.They also warn that current guidance ignores the fact that patients often respond differently to the same antibiotic,with some needing longer courses than others.Commenting on the research Alison Holmes,Professor of Infectious Diseases at Imperial College London said it was'astonishing'that doctors still do not know the optimum duration for taking drugs even though a long course raises the risk of bacterial resistance."The'complete the course'message directly conflicts with the societal messages regarding the changes needed in behaviour and attitudes to minimise unnecessary exposure to anribiotics,"she said.However.Professor Helen Stokes-l.ampard.Chair of the Royal College of GPs,said:"Recommended courses of antibiotics are not random-they are tailored to individual conditions,and in many cases courses are quite short,for example for urinary tract infections.three days is ofren enough to cure the infection.We are concerned about the concept of patients stopping taking their medication mid-way through a course once ihey'feel better'.because improvement in symptoms does not necessarily mean the infection has been completely eradicated.It's important that patients have clear messages and the message to always take the full course of antibioiics is well known-changing this will simply confuse people."Chief medical officer Dame Sally Davies,also said that the message to the public shoulcl remain unchanged until there was further research."National Institute for Health and Care Excellence is currently developing guidance for managing common infections,which will look at all available evidence on appropriate prescribing of antibiotics,"she said."The Departmcnt of Health will continue to review the evidence on prescribing and drug resistant infections.As we aim to continue the great progress we have made at home and abroad on this i-ssue."
Alexander Fleming cautioned that
A.more studies were required to decide whether to change guldance for using antibiotics to the public.
B.enough antibiotics should be used to prevent the spread of deadlier forms of disease.
C.patients under antibiotic treatment had long been worried about overuse.
D.patients should stop taking antibiotics as soon as they became unnecessary for them.
E.many advised courses were too short to treat diseases as minor as urinary tract infections.
F.changing the'always complete the course'message might bring about confusion to people.
G.doctors were supposed to have known the ideal length of antibiotic treatments.
