Does Completing Your Course of Antibiotics Reduce Antibiotic Resistance? (Follow-Up)
The follow-up debate (and backlash) to the BMJ article that hit the news just over 2 weeks ago would be interesting, I thought. And indeed it was. Out of 31 “Rapid Responses” to the article at BMJ itself at this point in time (almost all by physicians), 15 were against the conclusions of the article (or what they believed were the conclusions of the article – it is hard to tell sometimes), 7 supported them, 10 posted on related matters (including one that advertised the “response authors'” clinical trial!), while 4 were off topic. These responses came from all around the world, including Singapore.
The Guardian article reporting on this issue generated 1,148 responses, mostly negative or out of context, there is a follow-up article in The Hindu declaring that the BMJ article had “done more harm than good to antibiotic stewardship”, and there were even 3 Forum letters to the Straits Times in response to the article, which is a rarity.
Official guidance from many professionals and professional agencies continued to support the older public message to complete the course of antibiotics, as one might expect. Dame Sally Davies, U.K. Chief Medical Officer, stated that the message should not change until there is better evidence. The British Society for Antimicrobial Chemotherapy (BSAC) published an official statement stating that it was unable to support the call to “drop the course of antibiotics” at this point, while the World Health Organization (WHO) published an update stating that patients should always follow their doctors’ advice on duration of antibiotics, while backtracking from their initial advice that stopping antibiotics early would lead to antibiotic resistance.
Overall, I think this debate has been healthy and the BMJ article has elevated the issue of antibiotic prescription and antibiotic resistance temporarily into the public domain, which is good. What is less good is that the article itself may have been difficult to read and understand even for doctors, and the nuanced messaging that is necessary to convey the concepts discussed may well be too complicated for doctors and the public to bear (or at least it seems that way from the responses to date).
Perhaps more on this matter on another date…