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Indian Expert Contests BMJ Article On Antibiotic Resistance

An Indian expert on infectious diseases has strongly contested an article in the English medical journal, BMJ claiming that patients could stop taking antibiotic when they feel better saying ``there was no evidence that the infections will be cured and will not relapse if antibiotic are stopped when patient feels better’’ approach.

In a letter to the BMJ, Dr Abdul Ghafur, an authority on antibiotic resistance, who is also a consultant, Infectious Diseases at Apollo Cancer Hospital in Chennai, has said it was so unfortunate but not all all unexpected that journalists from around the world, in a short span of one week since the publication of the article, had written highly misleading articles conveying the dangerous idea that patients can stop their antibiotics when they feel better.  

“We need research to prove safety of `stop antibiotics when you feel better’ approach. Until researchers produce good quality evidence for all common types of infections, in various groups of patients, ranging from small children to elderly and immune-compromised, patients must follow the course as advised,’’ Dr Ghafur said.

While agreeing with the authors that the conventional argument of “completing the course of antibiotic’’ to prevent development of antibiotic resistance is not based on scientific evidence, Dr Ghafur said there was no disagreement among experts that, as far as antibiotic resistance potential is concerned, a shorter course is safer than a longer one. 

“There is more and more evidence in the recent literature for shorter course of antibiotics for many infections and expert guidelines are already recommending shorter courses wherever and whenever published good quality evidences for shorter courses are available,’’ the letter said.

Accusing the BMJ article of presenting this already well known truth as an out of the box revolutionary idea, the letter said that the ``controversial’’ articles create widespread discussion on important issues. ``Unfortunately this article has probably done more harm than good to the field of antibiotic stewardship. This article is based on concrete facts, but written in a highly misleading way and interpreted by media and the public in a dangerously erroneous style,’’ Dr Ghafur said.

The BMJ article, authored by Martin Llewelyn and colleagues, has said ``with little evidence that failing to complete a prescribed antibiotic course contributes to antibiotic resistance, it’s time for policy makers, educators, and doctors to drop this message.’’

 Antibiotics are vital to modern medicine and antibiotic resistance is a global, urgent threat to human health. The relation between antibiotic exposure and antibiotic resistance is unambiguous both at the population level and in individual patients. Reducing unnecessary antibiotic use is therefore essential to mitigate antibiotic resistance, the article says. 

“Avoiding overuse requires healthcare professionals and the public to be well informed about antibiotic treatment, as set out in the first objective of the World Health Organization Global Action Plan. Public communication about antibiotics often emphasises that patients who fail to complete prescribed antibiotic courses put themselves and others at risk of antibiotic resistance,’’ the article says.

For example, in materials supporting Antibiotic Awareness Week 2016 WHO advised patients to “always complete the full prescription, even if you feel better, because stopping treatment early promotes the growth of drug-resistant bacteria.” 

However, the idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence, while taking antibiotics for longer than necessary increases the risk of resistance. Without explicitly contradicting previous advice, current public information materials from the US Centers for Disease Control and Prevention (CDC) and Public Health England have replaced “complete the course” with messages advocating taking antibiotics “exactly as prescribed,’’ the article said.

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