IMPACT: The results show a need for nuanced communication between doctors and patients.
"Always finish your antibiotics" is no longer considered medical best practice for all conditions.
Surprised? You're not alone.
A new study has found that almost 90% of Americans believe that it's always best to take the full course of antibiotics, even when you feel better—consistent with long-running but now outdated health campaigns. The reality is more complicated. Sometimes shorter courses are safer, and sometimes longer courses are best.
The survey demonstrates a need for better communication between doctors and patients about what's healthiest.
"Historically, there was very strong guidance by major health organizations and clinicians that you must always finish the course," says Alistair Thorpe, PhD, research assistant professor of population health sciences at University of Utah Health and first author on the study. "Now, we're seeing a growing body of evidence saying that that is not always the case. And oftentimes, shorter durations of antibiotics are as effective and safe as longer alternatives."
The results are published in Open Forum Infectious Diseases.
A complex reality
The research team surveyed 1,475 people across the country on their attitudes about antibiotic course length. They asked participants whether they'd feel more comfortable taking a three- to five-day course of antibiotics if they had pneumonia, as is recommended by current guidelines, or if they'd prefer an antibiotic course of a week or more, which is recommended by outdated guidelines. While shorter courses of antibiotics are as effective and safer for pneumonia than longer ones, about 60% of people said they'd rather take the longer course.
One of the main reasons people gave for preferring longer antibiotic courses was that they had been told to "always finish their antibiotic course"—88% of respondents had heard of, and agreed with, this common mantra. Most had been told this by their clinician, and many had also heard it via a public health campaign.
A strong body of scientific evidence shows that, for many common infections, shorter courses of antibiotics work as well as longer courses and are less likely to cause side effects. Still, there are some cases, like tuberculosis, where longer courses are most effective.
The study authors suggest that doctors and public health campaigns use several evidence-informed strategies to better communicate the complex reality of antibiotic course length—for instance, avoiding overly simplistic claims that either shorter or longer courses are universally better, and acknowledging that as scientific evidence accumulates over time, health recommendations can change.
To patients who have been prescribed antibiotics, Thorpe recommends having an open conversation with your doctor about the appropriate course length and adherence plan to get health advice that's specific to your situation.
"Discuss with your clinician what the right duration is for you and when the right time is to stop your course," Thorpe says. "Getting advice directly from a clinician on a one-to-one basis about what is most appropriate for you in that situation is the right way to go."
Thorpe emphasizes that the changing recommendations are a positive outcome of increasing knowledge.
"Evidence is growing and guidance is evolving on antibiotic use, which is a normal process and a good sign that we are working to improve how we provide care," he says. "Our knowledge about how best to use antibiotics has changed, but it has changed because we're learning more, and it's important that we make sure we are communicating this well to the public."
