Is it time to stop counselling patients to “finish the course of antibiotics”?

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2024-12-28 05:00:03

How many times have you advised patients to “make sure you finish the course of antibiotic treatment, even if you feel better”? By far one of the most common counselling points in community pharmacy practice, finishing the prescribed course of antibiotics has been engrained upon generations of pharmacists and other health care professionals. Pharmacists certainly play a key role in encouraging patients’ adherence to medication regimens, but the emphasis on finishing the course is unique to antibiotics and goes beyond adherence.

In 1945, Alexander Fleming’s Nobel Prize acceptance speech for his penicillin discovery warned about the dangers of antimicrobial resistance.1 We are now facing antimicrobial resistance on a global scale some 70 years later. With 700,000 deaths annually (and rising) due to antimicrobial-resistant organisms, we are up against one of the biggest public health threats of our time.2 Now, more than ever, antibiotics must be viewed as a shared nonrenewable precious resource. As a result, in the past few years, a number of organizations, including the World Health Organization,3 United Nations4 and the Public Health Agency of Canada,5 have highlighted the threat of antimicrobial resistance and the role of antimicrobial stewardship in mitigating this problem.

In his Nobel lecture, Fleming spoke of a hypothetical situation where a person self-treats a sore throat with antibiotics, “He buys some penicillin and gives himself, not enough to kill the streptococci but enough to educate them to resist penicillin.” He advised, “If you use penicillin, use enough.”1 Although he was likely alluding to the risks of inadequate dosing, his quote has been construed to mean that inadequate durations of antibiotic therapy breed resistance. This belief, coupled with the underestimated risks of antibiotics and commercial disincentives to use less antibiotics, has shaped modern-day thinking about antibiotics. In fact, “finish the course” is based on 2 ideas about shorter courses of antibiotics that are unsupported by current evidence: 1) they are less effective, and 2) they lead to more resistance.