Shorter Antibiotic Courses May Be Better for Some Infections

Shorter antibiotic courses may be enough

You have probably been told that completing an entire course of antibiotics is vital to eliminate a bacterial infection and prevent antibiotic resistance.

That message has been common since penicillin was discovered in the 1940s. Yet a growing body of evidence indicates that, for some widespread bacterial infections, a shorter antibiotic course could be the preferable option.

There is no universal rule for prescribing antibiotics, and careful discussion between a patient and their doctor remains crucial. However, a new study by US public-health specialists, published in Open Forum Infectious Diseases, indicates that this nuance is not reaching patients.

"Historically, there was very strong guidance by major health organizations and clinicians that you must always finish the course," says Alistair Thorpe, a population-health researcher at the University of Utah.

"Now, we're seeing a growing body of evidence saying that that is not always the case. And oftentimes, shorter durations of antibiotics are as effective and safe as longer alternatives."

Communicating this change has proved difficult, as patients have spent decades hearing that lengthy courses are needed to eradicate bacterial infections before the microbes can re-establish themselves.

More than 120 randomised controlled trials over recent decades have shown that shorter courses for common infections may be equally effective, safer, and no more likely than longer courses to drive antibiotic resistance.

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Antibiotic resistance and treatment duration

Antibiotic resistance is a pressing global danger. Drug-resistant bacteria, or ‘superbugs’, kill more than 1 million people annually.

The use of antibiotics in agriculture has been identified as a significant concern, because contaminated wastewater can transport microbes downstream. Superbugs can also spread rapidly through hospitals. Meanwhile, dry soils may provide breeding sites for drug-resistant microbes able to travel through the air.

However, little evidence suggests that not finishing a prescribed antibiotic course itself encourages antibiotic resistance. Indeed, some specialists argue that needless antibiotic exposure caused by overly long courses may be adding to the problem.

For pneumonia, for example, shorter antibiotic treatment appears to work in reducing both recurrent infection and the spread of antibiotic resistance.

"Developing effective strategies for communicating updated guidance on antibiotic use requires understanding how patients' beliefs and preferences differ from current guidance," Thorpe and his colleagues write.

What patients prefer for antibiotic treatment

To explore these beliefs and preferences, the team surveyed 1,475 people in the US. They asked: "Which antibiotic course length would you feel most comfortable taking for a bacterial respiratory infection (eg, pneumonia)?"

Most participants (892) said they would rather take a long course lasting 7 days or more than a short course of only 3-5 days.

"This preference was related to several factors, including having been told by a medical professional to 'always finish a course of antibiotics' and a general belief that longer treatments are inherently better," the researchers note.

"Although very few respondents (17.5 percent) had ever been told to stop taking antibiotics when they feel better, many (58.4 percent) said that they would be at least somewhat comfortable hearing it from their clinician."

This distinction matters: ending antibiotics earlier than your doctor has prescribed can be risky. This is a news article, not medical advice.

The message is to follow the treatment your prescriber recommends, even when the course is shorter than you expected. That does not mean deciding the treatment length for yourself.

Some severe bacterial infections do need longer courses of antibiotics, including tuberculosis and particular staph infections.

"Acknowledging uncertainty and the evolving nature of scientific evidence can foster trust, understanding, and acceptance of changes," the authors suggest.

"Framing updates to antibiotic use as routine scientific progress may help patients adapt to changes."

More than 90 percent of those surveyed trusted their doctor’s advice. The authors describe this as an encouraging finding amid declining trust in science and healthcare.

Related: Droughts Are The Ideal Breeding Ground For Antibiotic-Resistant Bacteria, Study Warns

"Discuss with your clinician what the right duration is for you and when the right time is to stop your course," Thorpe says.

"Getting advice directly from a clinician on a one-to-one basis about what is most appropriate for you in that situation is the right way to go."

The findings were published in Open Forum Infectious Diseases.

This article was fact-checked and edited by Clare Watson. Although we take pride in our process, we are only human. If you notice an error, please tell us.