There is currently a trend among some Dutch people to be critical about the use of antibiotics, and the oversimplified publicity surrounding the recent article in the British Medical Journal is bound to increase the confusion. It is likely that many courses of antibiotics for uncomplicated disorders could be limited to less than the usual five, seven or fourteen days, which is usually determined by the doctor rather than by the patient. Many courses have already been reduced in duration when applied to previously healthy immunocompetent patients. Others remain longer, such as those for infections in the presence of artificial materials, often without supporting evidence.
There are, however, major risks associated with self-medication based on ‘feeling better’, including treatment failure, complications and the use of leftover drugs. The basic approach of the article, focusing on the resistance problem, is correct. It is clear that there is at present no evidence for a causative relationship between the duration of antibiotics courses and antimicrobial resistance. The article discussed here can, must and will lead to further research (e.g. into bactericidal and bacteriostatic agents) and to clear guidelines.
In order to limit resistance, what is certain is that
• there must be a clear indication for prescribing a course of antibiotics;
• the dosage of the antibiotic must be appropriate.
For now, the most sensible approach appears to be to stick to the current guidelines of the Dutch College of General Practitioners.
So what should doctors recommend their patients to do?
'Finish the course'.
- Llewelyn MJ, et al. The antibiotic course has had its day. BMJ 2017; 358: j3418 doi: 10.1136/bmj.j3418.
- Fleming A. Penicillin. Nobel lecture, 11 Dec 1945. https://www.nobelprize.org/nobel_prizes/ medicine/laureates/1945/fleming-lecture.pdf.
The literature refers to the Dutch text