One should always finish the prescribed course of antibiotics! How true is this cardinal rule?
It became a debatable topic lately as many news articles are coming up with contrasting standpoints. This could create ambiguity in people’s minds as their doctor advises them to always finish the prescribed course of antibiotics.
To clarify on this crucial topic, we have a doctor specialized in microbiology.
Dr. Kavita Diddi is not just a practicing health care professional, but also an ardent science communicator conveying the right awareness to the public.
With her initiative, an antibiotic steward committee for clinics (exclusively for outpatients and doctors) was formed in the Prime healthcare group, UAE to promote the judicious use of antibiotics in the outpatients. The program intends to educate both the patients and doctors about the antibiotics and it’s abuse.
Let’s start with the most common and basic doubt among the people.
Question: Is it necessary to finish the prescribed course of antibiotics?
Very important, as the incomplete course can lead to treatment failure or recurrence of infection. Most antibiotic treatment recommendations for 3-5 days. Longer than that course is recommended in a few specific conditions where bacteria hidden in areas of the body where penetration of antibiotics is difficult.
Question: Do the patients finish the prescribed course of antibiotics? What could be the common reason for discontinuing the course of antibiotics?
I am not directly involved in prescribing antibiotics, but I feel the most common cause is a better feeling of the patient after a few doses and then they feel unnecessary to complete the course. And sometimes it could be the side effects related to antibiotics as diarrhea is very common with penicillin type of drugs.
Question: An article published in the British medical journal titled “The antibiotic course has had its day” says that patients are at unnecessary risk from antibiotic resistance when treatment is given for longer than necessary, not when it is stopped early.
I feel the caption is wrong, in terms one needs to complete the course of antibiotics not because the incomplete course will lead to an increase in antibiotic-resistant but it will lead to treatment failure.
Antibiotic resistance is still a big problem and the most common reason is selection pressure created over bacteria by injudicious use of antibiotics. One should prescribe or take antibiotics whenever it is required only.
As per the CDC, 30% of antibiotic prescriptions are unnecessary in outpatients. This unnecessary use gives a pseudo believe that an incomplete course of antibiotics is also good enough. Example- The most injudicious use of antibiotics happens in viral pharyngitis. Viral pharyngitis usually resolves spontaneously in 3-5 days. If someone takes antibiotics for viral pharyngitis and leaves the course incomplete and gets a pseudo feeling for not completing the antibiotic course is alright.
Question: How is the duration of antibiotic treatment decided?
Duration of treatment decided by lots of factors.
- Organism- Some bacteria are hard to kill or get mutated easily to resist antibiotic effect.
- Drug- the type of antibiotic, its chemical property and metabolisms, and half-life
- Host factor- site of infection
Question: How are antibiotics prescribed? Is it based on the laboratory reports indicating causative bacteria and antibiotic susceptibility assay? Or have patients prescribed antibiotics on their first visit to speed up the recovery process?
Prescribing antibiotics will depend on the clinical condition of the patient. If clinically symptoms and initial lab reports are in favor of viral infection, doctors and patients should wait for culture reports before prescribing antibiotics. If a patient presents with severe symptoms, antibiotics could be prescribed as per the local antibiogram. After the culture report, it should be reviewed and tapered accordingly.
Question: How aware are the patients about antibiotics and antibiotic resistance? Is there any antibiotic awareness program?
In our group (Prime healthcare group, UAE), the antibiotic stewardship committee for clinics has been formed and I am chairing this committee. The purpose of this committee is to make the patient and doctor aware of the misuse of antibiotics.
While reporting of culture and antibiotic sensitivity to organisms, I can see a surge in antibiotic resistance with time. To keep a check on this as a part of the antibiotic stewardship committee, we educate clinicians for judicious use of antibiotics as well as patients in the form of TV display, pamphlets for not to demand to clinicians for prescription of antibiotics as well as to ask clinicians whether prescribing antibiotic is necessary if clinicians are prescribing.
Question: In your opinion, what types of patients are the major consumers of antibiotics?
During auditing prescriptions, it was found most misuse of antibiotics happens in OPD (outpatient department), up to 30% as per the CDC, and up to 50% wrong prescription in terms of choosing the wrong antibiotic or dose or duration of antibiotic.
The reason could be to avoid revisit of the patient, patient pressure, fear of getting a secondary bacterial infection so it is ok to overtreat.
Question: Have you ever encountered a situation where patients request for the antibiotics?
No personal experience but yes, lots of my colleagues face this problem, and mostly the patient wants to avoid revisit and wants an antibiotic prescription.
For patient education, we have prepared different types of education material, which can be used by clinicians as a reference to educate patients regarding the unnecessary use of antibiotics.
Question: Often public comments that the doctors prescribe antibiotics for the common cold caused by the virus. And sometimes doctors back this argument by explaining it is to prevent secondary infections from the bacteria. What is your opinion on this?
Secondary bacterial infection can happen, but the percentage is very less. Continuous monitoring of symptoms will give early clues to develop a secondary bacterial infection. So, it always better to wait before prescribing antibiotics in suspected viral infection. This injudicious use of antibiotics creates a selection pressure for the development of antibiotic resistance.
Question: Are there any alternative therapies available here in the UAE to overcome the over-dependency on antibiotics and problems associated with antibiotic resistance?
Not many alternatives to antibiotics are available and whatever available is mostly in experimental stages or lack of funding to do more research.
There is lots of work done on phage therapy but still not approved for common use. In phage therapy, we use viruses to kill bacteria causing infections. It showed good results with lots of speculation regarding side effects as we are introducing living viruses in the human body, the effects can not be predicted 100%. So the cost-benefit ration of giving a virus is not yet clear.
Currently, antibiotics are the only options for the management of bacterial infections. If we use it judiciously, no need to further invest in search of new agents because of resistance. We need to find new molecules for better efficacy, dosing, fewer side effects but not resistant.
Question: As a practicing healthcare professional specialized in microbiology, how do you consider the antibiotics? Are they really the miracle medicines?
The Discovery of antibiotics is a major game-changer in the history of medical science. Post antibiotic era, the mortality rate due to infectious organisms decreased drastically, and the average life age of humans also improved.
RELATED: Why microbes produce antibiotics?
The development of antibiotic-resistant went hand on hand together, due to selection pressure. To a certain percentage, antibiotic-resistant is unavoidable and acceptable also.
But due injudicious of antibiotics in humans as well as in the animal, led to a dramatic increase in resistance. This needs to be stopped, otherwise, we are not away from a stage, where we will leave without antibiotic to use as the speed of development is much faster than discovering a new antibiotic molecule.
End of the interview
The prescribed course of antibiotics is “not random” but tailored to the patient’s individual treatment requirements.
Based on the new researches and numerous trials, the international and national medical regulatory bodies update the guidelines to healthcare professionals.
Therefore, the message to the public remains the same, to seek the advice of healthcare professionals.
The views and opinions expressed in this interview are exclusive to the interviewee.
The article does not express views and opinions of livingwithmicrobes and the organization to which the interviewee belongs.
About Dr. Kavita Diddi
Dr. Kavita Diddi did her post-graduation in microbiology from the most prestigious college, AIIMS, New Delhi in India. There she was also in-charge of undergraduate medical student teaching and involved in various research activities and published her work in international and national journals related to virology and bacteriology.
Before moving to UAE, she worked in a private tertiary care hospital in India. Here in UAE, she is associated with the Prime Health care group, UAE. In the Prime Healthcare group, she is taking care of Microbiology and Serology division as well as in charge of the training and competency department of laboratory division. She is also Chair and co-chair for the Antibiotic Stewardship committee (clinics) and Infection Control Committee (hospitals and clinics), respectively. Because of her initiative, Prime Healthcare started an Antibiotic stewardship committee for clinics to promote the judicious use of antibiotics in OPD patients. She is also Lead assessor for ISO 15189:2012.
She is also the General secretary for Emirates Society of Clinical Microbiology (ESCM), UAE. She got special recognition from HH Sheikh Hamdan bin Mohammed bin Rashid Al Maktoum and DHA as front liners of the COVID-19 task force team at Prime Healthcare Group, UAE.
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