There is limited evidence to support the need to complete a ‘course’ of antibiotics – when a patient’s symptoms have resolved.
In a sports medicine context, especially at the elite level, there is often pressure to aggressively treat a player’s injury or illness. This is especially true when a player is unwell. There is often considerable pressure to treat them with antibiotics – despite the understanding that in many cases there is a viral aetiology.
A recent article, and subsequent editorial, in the BMJ has suggested that it may not be necessary for a patient to complete their prescribed ‘course’ of antibiotics.1,2 Current practice is to advise patients to complete the prescribed course of antibiotics, even when their symptoms have already resolved. The rationale for this practice is to prevent the development of antibiotic resistance. This is contrary to what commonly happens in a hospital setting (where antibiotics are discontinued when the patient’s symptoms and signs have resolved). The authors of these publications argue that there is no evidence stopping antibiotic treatment early encourages antibiotic resistance. Taking antibiotics for longer than necessary however does increase the risk of resistance.
Based on the advice from these experts, and their review of the literature, evidence for the effectiveness of a ‘course’ of antibiotics for more minor respiratory infections is very limited. In this setting, stopping the antibiotic when the patient’s symptoms have resolved is not unreasonable. For more serious infections however we should still be encouraging our players to complete the ‘course’ – and arranging regular review to make sure that the infection is resolving.
Disposal of the unused antibiotic is an important consideration. There is a risk that players will stock-pile unused drugs and keep these for later use. This is clearly not appropriate.
1 Llewwlyn MJ, Fitzpatrick JM, Darwin ED et al. The antibiotic course has had its day. BMJ 2017;358:j3418
2 Del Mar C and Looke DFM. Should we abandon “finishing the course” of antimicrobials? It depends on the type of infection. BMJ 2017;358:j4170