You Still Need to Stop Taking Antibiotics, but Ask These Questions First
You have seen the labels on your antibiotic prescriptions: FINISH ALL THIS MEDICINE unless directed by your doctor. This has been dogmatic for years, but in reality, this rule may not be the best way to prevent antibiotic resistance. But don’t throw away your half-used penicillin bottle just yet.
Some doctors talked loudly about the idea in a medical journal this week , but they were trying to get the message across to doctors, not to you at home swallowing pills. They note that the CDC and its British equivalent are advising people to take their medications “as prescribed,” rather than insisting that we complete the course. This gives providers the ability to prescribe shorter courses of treatment when it makes sense.
Why Longer Courses of Antibiotics Are Not Always Better
You’ve heard the story that you need to kill all the bacteria that make you sick, and if you miss a few – say, stop taking your medications prematurely – they can develop resistance and bounce back. But in reality, this is not how it works. If the bacterial army inside you includes several antibiotic-resistant members, they don’t have to be killed.
In fact, the longer you take the medication, the more susceptible bacteria you kill, and the more resistant ones remain. And if you have a really resistant infection, your doctor will prescribe different antibiotics for you – maybe even several types – instead of just re-prescribing the prescription that didn’t work.
So why do we have to take pills for 10 or 14 days? For many infections, we simply don’t have enough research to clearly state what the minimum course is to treat them. Thus, healthcare providers are mistaken in favor of longer courses of antibiotics over shorter ones. In the end, it would be very bad if you didn’t have enough medicine and your infection returned after it seemed like you started getting better.
But in many cases, there is too much of a standard recipe. With some diseases, three days will be enough. However, it depends on the circumstances: one recent study of children with ear infections showed that they really need a full ten days.
Meanwhile, what really causes resistance is primarily the overuse of antibiotics, for example, in viral infections that do not need them. The BMJ’s report concludes: “The public should be encouraged to understand that antibiotics are a precious and finite natural resource that must be conserved.”
Ask if you really need antibiotics (and respect the answer)
So what is the patient to do? First, be aware 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 asks three questions :
- Do I really need antibiotics for this? I always ask this question, and you will be surprised how often the answer will be something like this: “Actually, you can do it anyway. Want a paper prescription that you can write out in a few days if you don’t feel better? “
- Can I get a short course of antibiotics? Sometimes this is an option.
- Several days have passed and I feel better. Can I stop taking antibiotics? Again, this is specific, but sometimes the answer is yes.
Don’t be afraid to ask questions or voice concerns. Your provider will not be offended. I’ve even seen friends suggest that they need to stop taking the medication, even if they have a bad reaction to it. No need! Call up your document and discuss it. They usually give you the green light to stop taking the drug and can write a prescription for something else if you are not already feeling better.