Completing a “course” of antibiotics may not be necessary.

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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.

To learn more about the use of antibiotics and the treatment of infectious conditions complete the Infectious Diseases module in the FIFA Diploma in Football Medicine.

References

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

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Bangoura
Bangoura
20 January 2018 14:38

Bonjour j’ai bien compris votre question

Karamo B Touray
04 February 2018 22:28

Antibiotics are misuse by most team physician, I have to capture a context of African football. This is what I knew especially the Gambia. Because lack of or low knowledge by most team physician in football has deserted ethics in their work as health ambassadors and causing players lost of confidence in their health personnel. Antibiotics are good treatment protocols if caregivers knew or know the purpose meant for.`

Bangoura
Bangoura
15 February 2018 15:50

La médecine du sport est la science de l homme sain en mouvement il y’a une nuance entre blessure et maladie quant c est une maladie infectieuse(bactérienne ou virale il faut utiliser des antibiotiques sur la base d un antibiogrmme et arrêter le traitement lors que les symptômes ont disparu il y a toujours un délai d utilisation des antibiotiques en fonction du degré d infectionet éviter aussi une éventuelle résistance à tel ou tel antibiotique

Karamo B Touray
04 February 2018 22:28

Antibiotics are misuse by most team physician, I have to capture a context of African football. This is what I knew especially the Gambia. Because lack of or low knowledge by most team physician in football has deserted ethics in their work as health ambassadors and causing players lost of confidence in their health personnel. Antibiotics are good treatment protocols if caregivers knew or know the purpose meant for.`

Mark Fulcher
09 February 2018 0:14

Thanks for the feedback ANY. This is indeed a difficult area. Players, and patients in general, have an expectation that their doctor will ‘do something’ when they are sick. They are not happy when they leave with advice – rather than a medication. A recent study showed the a patient’s satisfaction was inversely proportional to their doctors perception of the quality of medicine they delivered. In more simple terms when a doctor prescribes an antibiotic for an URTI (when they consider it to be a viral illness) the patient is happy with the service they receive. We have an important… Read more »