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BSI response to article on how long antibiotics should be taken for

27 July 2017

An article published today in the British Medical Journal has argued that it is time for healthcare professionals to drop the message to “complete the course” of antibiotics. The authors argue that this approach to stopping the development of antibiotic resistance is not backed up by evidence. In response to this article, the British Society for Immunology has issued the following statement:

Professor Peter Openshaw, President of the British Society for Immunology and Professor of Experimental Medicine at Imperial College London said:

“I have always thought it to be illogical to say that stopping antibiotic treatment early promotes the emergence of drug-resistant organisms. This brief but authoritative review supports the idea that antibiotics may be used more sparingly, pointing out that the evidence for a long duration of therapy is, at best, tenuous. Far from being irresponsible, shortening the duration of a course of antibiotics might make antibiotic resistance less likely.

“It could be that antibiotics should be used only to reduce the bacterial burden to a level that can be coped with by the person’s own immune system. In many previously healthy patients with acute infections, letting them stop the antibiotics once they feel better has considerable appeal.

“However, there are clearly circumstances where antibiotics should be given for extended periods. This includes conditions where the host’s immune response is unable to cope well with the infection, where there is poor tissue diffusion of the antibiotic into the area of infection, or when the organism is very slow growing or can lie dormant (tuberculosis, for example).

“Ideally, there should be clinical trials to support the duration of therapy but in the meantime it should be up to the prescriber to recommend how long to continue treatment.”

The full article that this statement is in response to can be found at: Llewelyn et al. 2017 The antibiotic course has had its day. British Medical Journal 358 j3418 doi: 10.1136/bmj.j3418