Here is the answer to last weeks poll question! What increases the risk of antibiotic resistance?
A) Failing to finish an antibiotic prescription
B) Long term use of antibiotic prescription
C) Both increase the risk
D) Both decrease the risk
The suspense is about to end. It was a question to setup this week’s discussion. And like any well-written poll question two answers must be somewhat right. The poll results demonstrated that the majority answered C and that was what I was expecting. The goal is to bring some perspective to answer C and some consideration for answer B.
This poll question was inspired by an experience I had while taking the pharmaceutical prescribing course for naturopathic physicians in BC. A renowned pharmacist teaching the course simply asked us the above question. In perfect unison we answered “c” looking to show off our brilliance on such a simple question. Our answer was followed by a slight pause. I was starting to feel like we had been setup.
He responds, “Well which is it? Taking an antibiotic for too long or not too long?? It can’t be both.”
I know, you want to rebuttal. Of course, if you cease taking your antibiotic before you have kicked the infection you can contribute to antibiotic resistance. Simply, this is because the bacteria that survive will learn to adapt and outsmart the antibiotic. We also know that individuals who are on long-term prescriptions of antibiotics are at increased risk of antibiotic resistance. This isn’t really what he wanted to emphasize. Neither do I. I’m sure these two facts are why you answered C in the first place.
The question really is then: Is failing to finish an antibiotic prescription in itself really increasing you risk? Are there better markers for ceasing the prescription than the one written on the prescription pad?
He left this question hanging and started asking us his next series of questions. “Has anybody seen an antibiotic prescription for 5 days??” We raised our hands. “7 days?? How about 10 days” We raised our hands. “How about 4?? Or 6?? Or 8 days??” Nobody raised his or her hand.
“Of course not! You can’t possibly prescribe for 4, 6 or 8 days because nobody does that and you will look foolish”. He continued to say with a slight grin. “Welcome to the art of prescribing.”
The point was understood. We have been trained to think that hell will freeze over if we do not finish that prescription. The reality however is that the length of the prescription is based on clinical experience and can vary for various factors including the prescribers biased preference for a 10 day versus a 7 day prescription. Another reality is that prescribing physicians can’t tell the future and can’t always tell whether you will need 7 or 10 days worth of antibiotics or heck maybe you are in real need of the forbidden 8-day prescription! There really isn’t any evidence that a person who was prescribed the antibiotic for 7 days versus 10 days had different risk of antibiotic resistance.
So here are a few take home messages.
• If you have a non-life threatening infection and you have been symptom free and fever free for 48hrs it is wiser to stop taking the antibiotic regardless of the prescription length. You will decrease you risk of antibiotic related complications such as diarrhea and decrease the risk of antibiotic resistance.
• Do not prematurely cease taking your antibiotics if you are still experiencing symptoms and fever. Consider revisiting your primary care physician to discuss the prescription if you are nearing the end.
• Consider taking strain specific probiotics that have been shown to decrease antibiotic associated complication.
That’s it! Just some juicy food for thought!