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THE CRUX

SCIENCE SMACKDOWN

TIME TO CHANGE NOT JUST YET

THE MESSAGE

Stay the Course?

Researchers debate whether we should finish our antibiotic prescription.

YOU’VE HEARD IT FOR YEARS: When you get antibiotics,

finish the prescription even if you feel better. Otherwise,

the bug might develop antibiotic resistance — a growing

problem that’s making infections harder to treat. But

a recent commentary in The BMJ argues that advice

needs updating; stopping the meds might be better.

In Science Smackdown, we invite experts to debate both

sides of the issue.  TEAL BURRELL

It’s been known for

decades that stopping

antibiotics early doesn’t

cause resistance,

says Martin

Llewelyn,

author of

The BMJ

paper

and an

infectious

diseases

professor at

Brighton and Sussex

Medical School in the U.K.

For most of the bacteria

posing threats today, it’s

just the opposite: Longer

exposure to antibiotics

increases the risk they’ll

develop a resistance.

To curb this, Llewelyn

and colleagues urge

doctors to drop the

“complete the course”

rhetoric and instead advise

patients to stop when they

feel better. “Many of the

course durations that we

recommend for antibiotics

are probably too long for

most patients,” he says.

Advising patients

to stop their

meds early is

premature,

says William

Schaffner,

a preventive

medicine and

infectious diseases

professor at Vanderbilt

University School of

Medicine. He cites a

2016 study of children’s

ear infections where

a shorter antibiotic

course led to relapse.

“Just because they were

feeling better didn’t

mean that their infections

were sufficiently treated

to stop therapy,” he says.

He agrees with the

goal of using fewer

antibiotics, but he thinks

rigorous studies need

to be performed for

each and every kind

of infection before

doctors change their

recommendations.

Rather than suggesting

patients quit when they

feel better, “this is a call

to the profession to do

better studies,” Schaffner

says.

The Claim The Counterpoint

FROM LEFT: COURTESY OF MARTIN LLEWELYN; VANDERBILT UNIVERSITY MEDICAL CENTER; MARCTRAN/123RF