Another one bites the dust
Andre Willers
7 Jan 2015
This is not medical advice .
Synopsis :
Taking full antibiotic courses even after being cured seems
to worsen antibiotic resistance .
Discussion :
Another medical myth
bites the dust ...
See Appendix A
Less is more .
The system as a whole
needs to be considered .
Big Pharma once again led
everybody by the nose .
They made resistant
hospital infections more likely by pseudo-scientific arguments not backed up by
any hard evidence .
I see a very large
class-action suit (like tobacco) coming .
“Pharma , pharma on ball
Who is the biggest pill
of them all?”
Andre
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Appendix A
Stop Taking Antibiotics When You Feel
Better?
Conventional wisdom: Antibiotic regimens should be taken in full, even after the
patient feels healthy again.
Contrarian view: Shorter courses are often just as effective and do a better job
at preventing antibiotic resistance.
You know the drill: When you’re prescribed a typical seven- to
14-day antibiotic course, do not, repeat, do not forget to
take all the drugs. This take-all-your-pills orthodoxy, championed since the
discovery of antibiotics some 70 years ago, is based on eliminating all
bacterial culprits as quickly as possible.
Doing so, in theory, reduces the odds that the bugs will develop
random mutations or pick up drug-resistant genes from other bacteria. Plus, the
sustained antibiotic onslaught supposedly ensures that any hardier, partially
drug-resistant bacteria also succumb, and thus don’t pass on “stepping-stone”
genes leading to full-blown resistance.
An emerging view, however, suggests that standard long
antibiotic courses are wrong on both counts — they’re no better than shorter
courses and actually promote antibiotic resistance.
“The science is clear,” says infectious disease specialist Brad
Spellberg of the Los Angeles Biomedical Research Institute. “Every study that
has been done comparing longer versus shorter antibiotic therapy has found
shorter therapy just as effective.” A few days of taking antibiotics, it seems,
should usually be enough to knock infections on their heels, allowing the
patient’s immune system to come in and mop up.
Taking the full course of antibiotics unnecessarily wastes
medicine, and more drugs translates to increased evolutionary pressure on the
harmless bacteria in our bodies. These “good” bugs can develop drug-resistant
genes, which can then transfer to bad bugs.
Furthermore, wiping out drug-susceptible bacteria in infections
too quickly makes it easier for drug-resistant bacteria to compete over a
host’s resources. Better access to nutrients lets the mutant bugs multiply far
more rapidly, upping the odds that they’ll reach a so-called “transmissible
density.” That means the resistant bacteria proliferate so much that they can
escape and infect another person.
In essence, if you take all those extra antibiotics, you might
be doing the worst bugs’ dirty work for them by removing a check on their
growth.
Shorter antibiotic regimens, in contrast, intentionally allow
some susceptible bacteria to survive in order to help suppress any resistant
pathogens. A recent study showed just this: Mice infected with both
drug-susceptible and drug-resistant malaria, when treated less aggressively,
were 150 times less likely to pass on the resistant pathogens.
Multiple studies demonstrate how doctors might gauge when to end
antibiotic therapy. (See “Less Is More? Selected Studies” below.) Thriving bacteria
raise blood levels of the hormone precursor procalcitonin, for example; guiding
treatment based on procalcitonin concentrations led to half as much antibiotic
use across seven studies, with no drop in cure rates. More signs of improved
health, such as fever alleviation, could also indicate antibiotics are no
longer necessary.
Overall, the accumulating data lend support to the heretical
notion of patients, in consultation with their doctors, stopping their
pill-popping upon feeling better. “The issue of continuing therapy until all
doses are done is an old wives’ tale,” Spellberg says. “There’s no data to
support it. You can’t make a cured patient better.”
Less Is More? Selected
Studies
• Mild to moderate
pneumonia: Three days is as
effective as eight (el Moussaoui et al., 2006, British Medical Journal);
four studies suggest three days is as effective as five in children
(Haider et al., 2008, Cochrane Database of Systematic Reviews).
• Hospital-acquired
ventilator-associated pneumonia: Eight days is as effective as 15 (Chastre et al., 2003, Journal
of the American Medical Association); eight studies suggest for certain
pneumonias, seven- to eight-day courses have better outcomes than 10 to 15
(Pugh et al., 2011, Cochrane Database of Systematic Reviews).
• Acute pyelonephritis
(kidney infection): Seven days is as
effective as 14 (Sandberg et al., 2012, The Lancet).
• Septic arthritis (joint
infection): Twenty days can
cure most cases compared with the typical one to two months of antibiotics
usually accompanied by surgery (Peltola et al., 2010, The Pediatric
Infectious Diseases Journal).
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