• New report says completing a course of antibiotics even after symptoms abate is overrated
    http://www.news-medical.net/news/20170726/New-report-says-completing-a-course-of-antibiotics-even-after-symptoms

    Vers une remise en cause de la stratégie d’utilisation des antibiotiques ?

    Scientists have explained the mechanism of development of antibiotic resistance.

    • Target selected resistance - When a microbe multiplies within the host it leads to infection. These microbes may undergo genetic mutations that may make them deadlier and resistant to antibiotics. These genetic mutations are seen to be accelerated in case of inadequate dosing of the antibiotics or when a single drug is used to kill the microbe. Tuberculosis, HIV, typhoid, malaria and gonorrhoea are notable infections that develop resistance in this manner.

    • Collateral selection – There are several bacteria types that live harmlessly within the gut or other mucus membranes. During antibiotic treatment for other infections, these harmless bacteria genetically mutate to become resistant and cause infections. Their mutations are passed on to other strains of the bacteria leading to antibiotic resistance. Organisms that show this type of resistance include Methicillin Resistant Staph aureus (MRSA).

    Researchers have seen that most of the antibiotic resistance now does not come from the first type of resistance selection or target selection. This means the second type is more common. This also means that longer the duration of the antibiotic use, longer the time the harmless bacteria in the gut gets to develop resistance and pass it on to the other strains and species of bacteria. These harmless bacteria are called “opportunistic pathogens” which means they become dangerous only at certain times i.e. antibiotic use, immunosuppression etc.

    In this new work, researchers have suggested optimum usage of antibiotics as the key to prevent resistance.

    • L’article original (accessible)

      The antibiotic course has had its day | The BMJ
      http://www.bmj.com/content/358/bmj.j3418

      Key messages
      • Patients are put at unnecessary risk from antibiotic resistance when treatment is given for longer than necessary, not when it is stopped early
      • For common bacterial infections no evidence exists that stopping antibiotic treatment early increases a patient’s risk of resistant infection
      • Antibiotics are a precious and finite natural resource which should be conserved by tailoring treatment duration for individual patients
      • Clinical trials are required to determine the most effective strategies for optimising duration of antibiotic treatment

    • Why you really should take your full course of antibiotics
      https://theconversation.com/why-you-really-should-take-your-full-course-of-antibiotics-81704


      Feeling better doesn’t mean you’re past the worst.
      Jonathan Cox, Author provided

      An article in the BMJ argues that contrary to long-given advice, it is unnecessary to make sure you finish all the antibiotics you’re prescribed. The article sparked debate among experts and more worryingly widespread confusion among the general public, who are still getting to grips with what they need to do to stem antibiotic resistance. Even my colleagues at the university this morning were asking me whether or not to finish their course of antibiotics.

      As an active campaigner for action to halt the progression of antibiotic resistance and a firm promoter of the “finish the course” message, the article and that the scale of coverage concerns me greatly.
      […]
      Only time will tell as to what the impact of suggesting people stop taking antibiotics when they feel better will be. I believe this has undone a lot of the hard work scientists like myself have invested in improving antibiotic awareness and personal responsibility surrounding antibiotic administration. Nevertheless, we all need to follow the advice of our clinicians who will no doubt hold out for some more conclusive scientific evidence before changing their advice surrounding antibiotics.