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"Complete the Course" Advice for Antibiotic Use


Which scientist played a role in the discovery of penicillin and is credited with starting the “complete the course” mantra of antibiotic use?

a. Howard Florey

b. Ernst Chain

c. Alexander Fleming

d. Norman Heatley

Answer: c

The “complete the course” sacred cow of antibiotic use has been uttered repeatedly by health care professionals ever since Sir Alexander Fleming said, "If you use penicillin, use enough,” during his acceptance speech for the 1945 Nobel Prize. He shared the award with Howard Florey and Ernst Chain for discovering penicillin’s curative effect on a variety of infectious diseases. Norman Heatley was part of Sir Fleming’s research team, but remains largely unrecognized for his groundbreaking work.

English researchers have now claimed that the well-established antibiotic mantra is based on hearsay instead of hard evidence and said taking antibiotics for longer than necessary increases the risk of resistance and leads to overuse of a finite resource.

Their controversial new report showed patients with strep throat, skin infections, and pneumonia who received shorter courses of antibiotics had the same cure rates as patients on longer courses. The only exception: Children with middle ear infections fared better after a 10-day course of antibiotics than children who took a 5-day course.

Dr. Sarah Walker, a professor of medical statistics and epidemiology at Brighton and Sussex Medical School in England and co-author of the report, said one of the reasons the “complete the course” advice is so resilient is that it is clear, simple, and unambiguous. However, she also pointed out that taking the full course of antibiotics flies in the face of the fundamental belief that patients should take as little medication as possible.

The report’s authors suggested more research is needed to support the effectiveness of alternative antibiotic treatment strategies such as “stop when you feel better,” and until another message is proven effective, they said patients should follow the advice of their doctors.

Experts from around the world were intrigued by the report’s suggestion but expressed concerns that relying on how patients feel to determine the course of antibiotic therapy is too subjective and said patients should continue to take the full course of antibiotics as directed by the healthcare provider who prescribes them.

Dan Cook

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