What if Our Antibiotic Prescribing Practices are Wrong?

How often have you emphasized to patients, family, and friends that they must finish their prescribed antibiotics, even if they feel better? A provocative new analysis in BMJ takes a close look at why standard antibiotic protocols may promote, rather than prevent, antibiotic resistance.

The authors’ arguments center around two key points:

  • The length of a course of antibiotic therapy is not evidence based, but rather “set by precedent [and] driven by fear of undertreatment.”
  • Typical, prolonged courses of these drugs cause endogenous or colonizing bacteria to become antibiotic resistant. It is these “collateral” organisms, they argue, and not the organism that has actually caused the infection, that drive the spread of antibiotic resistance.

Individualized antibiotic courses.

The BMJ authors present a strong argument for more individualized courses of antibiotic treatment. Unfortunately, when the news media picked up this story, much of what was written and broadcast erroneously suggested that everyone should simply stop their antibiotics when they feel better.

This simplistic message doesn’t take into account the ways in which different causative organisms, infection sites, symptomatology, or comorbidities affect the course of any infection. Imagine what would happen if people with tuberculosis stopped treatment when they felt like it, or if people hoarded leftover antibiotics to “prescribe” to themselves or family members in the future.

Many factors contribute to the problem of antibiotic resistance, including unnecessarily prescribed antibiotics and the extensive use of antibiotic drugs in factory-farmed animals. In the future, an emphasis on antibiotic therapy that is tailored to the individual patient may play an even more central role in antibiotic stewardship.

Learn details of the BMJ authors’ case for changing the basics of antibiotic prescribing in “Reconsidering Antibiotic Resistance” (free until December 27) in this month’s AJN. Read the article and share your thoughts. Could shorter, more individualized antibiotic regimens decrease the proliferation of resistant organisms?

 

Clinical editor, American Journal of Nursing (AJN), and epidemiologist

Comments are moderated before approval, but always welcome.

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