You've seen the labels on your antibiotic prescriptions: "FINISH ALL THIS MEDICATION unless otherwise directed by prescriber." It's been dogma for years, but this rule might not actually be the best way to prevent antibiotic resistance. But don't throw out your half-used bottle of penicillin just yet.
Some doctors spoke out loudly about this idea in a medical journal this week, but they were trying to get the message out to doctors -- not to you, at home, swallowing your pills. They note that the CDC and its UK equivalent both tell people to take their medicine "as prescribed" rather than insisting that we finish the course. That gives providers leeway to prescribe a shorter course of medication when that's what makes sense.
Why Longer Courses of Antibiotics Aren't Always Better
The story you've heard is that you have to kill all the bacteria that are making you sick, and if you miss a few -- say, by stopping the drugs early -- they could develop resistance and bounce back. But that's not really how things work. If the army of bacteria inside you includes a few members that are resistant to antibiotics, they won't necessarily be killed off.
In fact, the longer you take the drugs, the more susceptible bacteria you'll kill off, and the more resistant ones remain. And if you do have a resistant infection, your doctor will give you different antibiotics -- maybe even multiple kinds -- rather than just refilling the prescription that didn't work.
So why do we have to take our pills for 10 or 14 days? For a lot of infections, we just don't have enough research to clearly say what is the minimum course necessary to treat it. So providers err on the side of longer courses of antibiotics rather than shorter ones. After all, it would be pretty bad if you didn't have enough of the medicine, and your infection came back after it seemed you were starting to get better.
But in many cases, the standard prescription is overkill. Three days' worth is enough for some illnesses. It depends, though: One recent study on children with ear infections found that they really did need the full 10 days.
Meanwhile, what really drives resistance is overusing antibiotics in the first place, like for viral infections that don't need any. The authors of the BMJ opinion conclude: "The public should be encouraged to recognise that antibiotics are a precious and finite natural resource that should be conserved."
Ask If You Really Need the Antibiotics (and Respect the Answer)
So what's a patient to do? First, recognise that the number of pills in your prescription is your doctor's decision, not a law of the universe. Brad Spellberg of the University of Southern California Medical Center suggests asking three questions:
- Do I really need antibiotics for this? I always ask this question, and you'd be surprised how often the answer is something like, "This could go either way, actually. Would you like a paper prescription that you can get filled in a few days if you're not feeling better?"
- Could we do a short course of antibiotics? Sometimes this is an option.
- It's been a few days and I'm feeling better. Could I stop taking the antibiotics? Again, it depends on the specifics, but sometimes the answer will be yes.
Don't be afraid to ask questions or raise concerns. Your provider won't be offended. I've even seen friends assume that they need to finish their medicine even if they're having a bad reaction to it. No need! Call up your doc and talk it over. Usually they will give you the green light to stop taking the drug, and they can call in a prescription for something else if you're not better yet.