[neohaven]

The problem with stopping early is that you may have to start again. A whole course, since feeling better doesn't mean you have a low enough population of the bacteria to not reinfect you.

Surely, repeated/massive bottlenecks in a viral population aren't a good thing for antibiotic resistance.

Of course, the absolute best scenario to avoid resistance is to treat exactly as needed (say, kill 95% of the bacterial population, let the immune system clear the last 5%, done) but really, you can't realistically do that right now.

So you have two choices : Either you tell patients "Take it until the end even if you feel better!" which leads to some antibiotic resistance, or you tell them "Take them until you feel better!" which probably leads to reinfection and use of a second course of the same antibiotic.

Taking exactly enough > Taking more to make sure it's dead > Stopping too early, requiring the process to be done again.

[ddlatham]

However, this doesn't mean that the current courses that are being prescribed are in the sweet spot, and the article cites evidence showing that courses of certain shorter durations are just as effective as the currently prescribed longer courses at curing the infection, with the added gains of being less likely to produce resistence, more likely to be completed, fewer side effects, and cheaper.

It's unfortunate that the Slate article reprinting the The Conversation article discussing the British Medical Journal article used a title of "Stop taking antibiotics once you feel better" which is not what the underlying article is claiming.

[13of40]

I just had a round of antibiotics for an infected spider bite (no super powers) and the prescription amount and duration was extremely arbitrary - 2000mg/day of something for 10 days. I'm guessing not only are they not hitting the sweet spot, but they're prescribing multiple times more than someone would need, just to be safe, considering they don't know the strain of bacteria or anything relevant about me besides my weight.

[aaron_m04]

> "Stop taking antibiotics once you feel better"

I wonder if that counts as medical advice under the law...

[zeroxfe]

Why not: "take it until two days after you feel better"?

[gforge]

That's what I tell my patients, seems to work

[hyperpape]

You say this is necessary, the author says it's not. Why should I believe you (and same question for him)? Has the argument about the risk of reinfection been evaluated in the medical field?

[collyw]

I studied microbiology at university (over 20 years ago admittedly), but that was pretty much what they taught us. People often don't take the full course because they feel better, then the infection reestablishes itself.

They also taught us that vaccines are a good thing, yet plenty of people seem to be questioning that as well these days. Reading the replies here feels very like some of the smart sounding yet ignorant comments that some antivaccers make. :/

[hyperpape]

This guy says the conventional wisdom in the medical profession is wrong. I don't know if he's right, but just repeating the conventional wisdom seems like an unenlightening response.

[CamperBob2]

Problem is, that's all the columnist does as well. He states, over and over, that the conventional wisdom is wrong, but he never seems to get around to explaining why.

Incredibly weak article, IMO, regardless of the merits of what he's saying.

[hyperpape]

There's more than one medical authority and article cited (the 2007 piece, the more recent one, the WHO). It could be more detailed, I agree, but it's not like there's nothing there.

[erdojo]

Unrelated. There's a growing body of science backing up the idea that antibiotics are very often way over-prescribed, and that over-prescribing does NOT prevent bacterial resistance.

[collyw]

This was also taught to us over 20 years ago. Patients will often demand antibiotics for viral infections.

[ComodoHacker]

Actually author links to only one article from 2007 by Louis B. Rice, backing his point. Some meta-analysis would be more convincing.

[horsawlarway]

Doesn't adaptive immunity come into play here, though?

The goal of the antibiotics is to prevent the infection from killing you while buying time for your immune system to kick in and handle things.

Secondly, why would a second course be more harmful if the duration of the two courses combined is less total time than the initial prescribed amount?

If you feel better after 4 days of antibiotics, stop, get sick again and take 4 more days of antibiotics, you're still only dosing for 8 days. That's far better than a default of 2 weeks (14 days), and only barely worse than a 7 day course.

Now factor in the number of people who would have been just fine after 4 days, with no re-occurrence, and I'm really struggling to see why your advice is any better than: Treat when sick, stop when well. Even if you get sick again: treat when sick, stop when well.

[rplst8]

> I'm really struggling to see why your advice is any better than: Treat when sick, stop when well. Even if you get sick again: treat when sick, stop when well.

First, bacteria multiply very quickly. In the days between the first and second course, the bacteria could recolonize to the same number you had before. So it's not just as simple as taking the remainder of the course of antibiotics or even a slightly shortened one. You may need to take another full course. Additionally, those bacteria have had time to evolve and possibly become resistant.

Second, when you take antibiotics, it doesn't just kill the bad bacteria. Sometimes good bacteria dies as well. This can be disastrous to your health if done too many times.

[horsawlarway]

>>First, bacteria multiply very quickly. In the days between the first and second course, the bacteria could recolonize to the same number you had before. So it's not just as simple as taking the remainder of the course of antibiotics or even a slightly shortened one.

Sure, but where's the data collection that states taking it for a standard longer period is better than a repeated dose? Even if you have to bump the second dose to something like "Take until well plus 2 days, since you got sick again last time"? Not even mentioning that in most cases, your body actively gets better at handling the infection...

>>Second, when you take antibiotics, it doesn't just kill the bad bacteria. Sometimes good bacteria dies as well. This can be disastrous to your health if done too many times.

I agree, my issue is with the idea that taking it more times is ANY different than taking it longer. Why would two doses of seven days with a 3 day break between be any different than one 14 day dose?

----

Edit: I want to add, I'm aware that the idea with a longer dose is to lower total levels of the bacteria below the amount the immune system can handle. And if we don't hit that target re-infection can occur. My issue is that we're assuming here that longer is always better, and I simply don't think we actually have data to back that up.

[yourkin]

How likely is a reinfection, given that the body's immune system should be in head-on war mode by that time?

[rplst8]

I don't know other than saying "likely enough that doctors don't recommend not finishing the full course." Seriously, I find it hilarious that on HN that questioning a doctor's, no an entire field of science's, opinion on the matter goes nearly unfettered, but question the science behind climate change research and you'd better duck.

[erdojo]

You might, but the research is starting to become more and more clear that the "magic moment" is when you feel better.

We know that moment. At least, I do. When you're not really sick anymore but you're still recovering from the weakness left in the wake.

I have a group of doctors for an advanced immune system issue and this has been there advice for about four years. When I need antibiotics, we have top use the minimum dosage possible. So they tell me to stop when I feel better. And I do. I have bottles of half-full antibiotics in the bathroom drawer because of it.

My experience is only anecdotal, but I've never had to start over.

[pfarnsworth]

Your bias is crystal clear in the words that you choose.

"which probably leads to reinfection"

Probably? More than 50% chance? Which studies do you have to back this up or did you just make that up?