A hot topic: Is it really necessary to finish prescription antibiotics?

For years we’ve been taught to take all of our prescription antibiotics. Even if we feel better, it’s important to finish the whole course of treatment. Now that message is being challenged, and it’s a hot topic.

Antibiotics are problematic, and the cost of medicine is skyrocketing, so does it make sense to quit taking medication as soon as we feel better? Or, by not finishing, do we risk getting re-infected and then needing more, stronger medications?

What’s the backstory?

The problem began in 1941 when pure penicillin was used for the first time to treat a man who developed a life-threatening infection after pruning rose bushes. The new medicine worked. The man had a remarkable recovery – until his small supply of penicillin ran out a few days later. His infection worsened, and he died soon after.

Since then, doctors have erred on the side of caution, prescribing enough medicine to kill all the bad bacteria plus a bit more just to be safe. Traditionally a course of antibiotics has been 10 days, even if symptoms cleared sooner.

Antibiotics are tough on our bodies. Besides killing bad bacteria that cause infections, antibiotics also wipe out good bacteria that help us digest food, absorb nutrients and repair damaged tissue. As a result, we can suffer unpleasant side effects, such as nausea, vomiting, indigestion, cramping and diarrhea. We want to quit the medication as soon as possible because we want relief from the side effects.

But, if we quit taking the medicine too soon, we may not kill all the infection-causing bacteria. The surviving bacteria can rally, and the infection can worsen. And, if the bacteria have mutated and become resistant to antibiotics, the doctors may have a hard time stopping the infection.

What’s the deal with resistant bacteria?

According to the World Health Organization, a growing list of infections—pneumonia, tuberculosis, blood poisoning, gonorrhea and others—are becoming harder, and sometimes impossible, to treat because antibiotics are becoming less effective. WHO explains the domino effect that occurs when common antibiotics no longer work: We need new, more expensive medicine; we are sicker longer; we spend more time in hospitals; the cost of health care rises, increasing the economic burden on families and society; and the risk of death rises.

Using what they call the Goldilocks Principle, researchers have identified conditions that are “just right” for bacteria to mutate and become resistant. A Goldilocks condition can occur when patients take enough antibiotic to kill most, but not all, of the bad bacteria. The remaining bacteria can mutate in as little as 10 hours, becoming resistant to antibiotics.

Once bacteria mutate and become resistant to one type of antibiotic, doctors try to fight it with another antibiotic. Some types of bacteria have become so tough that there simply are no more options. They resist every form of antibiotic. When that happens, a simple infection can quickly turn into a life-threatening situation.

So, where do we stand now?

Researchers determine how much antibiotic is “just right” to fight a particular infection. They’ve discovered some infections need a full 10 days of treatment; some need as little as three days. It all depends on the type of infection and the patient’s personal medical history.

“The World Health Organization is constantly studying how different diseases react to various antibiotics,” says Jeff Shukhman, D.O., an internal medicine specialist at Facey Medical Group in Southern California. “They use science to set guidelines for the best course of treatment, and they modify the guidelines as new strains of bacteria and new antibiotics become available.”

Recent reports in the media suggest it is OK–and maybe beneficial–to stop taking antibiotics as soon as you feel better. They cite the body’s own ability to fight off infection along with fewer side effects and less exposure to medication as reasons to quit before the course of medicine is complete. Dr. Shukhman strongly disputes these pop-culture reports.

“Be very careful about what you read on the internet or see on TV. A lot of health-related stories just want to catch attention. They’re usually on controversial topics, and they use poorly designed studies,” cautions Dr. Shukhman. “On any given topic, it’s easy to find one poorly done study that offers ‘new’ results. It’s all about shock value and ratings.”

Doctors are encouraged not to over-prescribe antibiotics. Many doctors now start with watchful waiting and conservative measures instead of quickly handing out prescriptions.

“Most doctors are following strong, evidence-based medicine,” Dr. Shukhman says. “Listen to your doctors. Follow their advice even if it doesn’t match what you see in the media.”

If you have questions about your prescriptions or if you wonder whether it’s safe to quit taking a prescription, always talk to your doctors. They can discuss what course is safest for you.

A common sense approach

Consider these points if you think you need an antibiotic or if your doctor has prescribed one.

• At least 1 in 3 antibiotic prescriptions are unnecessary, says the Centers for Disease Control and Prevention. Antibiotics work only against bacteria, not viruses. Colds, flu, most sore throats and coughs are usually caused by viruses. Antibiotics won’t cure them. If your doctor doesn’t want to prescribe medication, don’t insist.
• Ask if there are remedies you can take to ease symptoms without taking antibiotics.
• If your doctor recommends a course of antibiotics, take the full amount as prescribed. Do not stop even if you no longer feel sick. (When you feel better, you may call your doctor and ask if it is safe to stop taking the medicine.)
• Do not skip doses. These medicines are most effective if taken regularly, as prescribed. Taken sporadically, they may lead to antibiotic resistance.
• Do not take medicine prescribed for someone else. Doing so may mask your symptoms and cause a delay in getting the correct treatment.
• Dispose of any unused medicine you may have. See our handy infographic for details.