[chris (OP)]

According to a recent publication in the British Medical Journal, advice "always to complete the course" may not be appropriate and could do more harm than good:

http://www.bmj.com/content/358/bmj.j3418

What does everyone here think? Is it time for a rethink?

[evan_au]

Surely, the ideal situation is to keep the patient alive (and relatively pain-free) long enough for his own immune system to recognize the pathogen, and take down this infection, plus take instant action on any future exposure that is similar to this pathogen.
- If you have some indication that the immune system has gained the upper hand (they mention fever reduction), then that would be a good time to stop a course of antibiotics.
- In many cases, the symptoms that alert us to an infection are not symptoms of the pathogen itself, but are inflammation or fever, which are both signs that the immune system is already taking action. In this case, it is questionable whether antibiotics should even be started.

For the individual:
- Too short a course of antibiotics, and you will be left with a resistant population, so you get a recurrence of the infection, and that antibiotic may not work next time. (Bad)
- Too long a course of antibiotics, and you will further reduce the diversity of your microbiome, and you will induce antibiotic resistance in your normal bacterial population. This may cause an immediate gut infection (like clostridium dificile), or a later infection by normal bacteria in your body which are now more antibiotic-resistant (like staph aureus). (Bad)

For the community:
- Too short a course of antibiotics for the individual, and any bacteria they pass on will be partially resistant. (Bad)
- In any case, any bacteria which the individual passes on after 1, 2, or 3 days of antibiotic treatment will be partially resistant anyway, even if the individual completes the full course. So infection control while taking antibiotics is important
- A fraction of the antibiotics we take ends up in the sewer, in sewage treatment plants and in rivers downstream of the treatment plant. Taking too long a course of antibiotics increases the exposure of these bacteria to continuous low levels of antibiotic, and promotes spread of antibiotic resistance genes.
- Individuals taking antibiotics for conditions they can't help (eg the common cold) unnecessarily increases antibiotic usage.
- Continued feeding of low-dose antibiotics to farm animals also promotes spread of antibiotic resistant genes.

Patients are put at unnecessary risk from antibiotic resistance when treatment is given for longer than necessary, not when it is stopped early

I think that the bit in bold overstates the case. If the antibiotics are stopped before the immune system has recognized the pathogen, then the patient is put at risk from the pathogen.

It can take 3 days to 2 weeks after the start of an infection to initiate an effective immune response.
- So most infections will clear up by action of the immune system with or without antibiotics
- Delayed prescriptions (mentioned in the article) are a good idea - find out when symptoms started, add a week, and say to the patient "If it hasn't got any better by X days, take this prescription.".

[mrsmith2211]

Well it might be old school, but it is best to complete the course, as the surviving whatever due to early stoppage of medicine now are immune to the treatment and create drug resistant variations.

[Danne]

Definetely comple the antibiotic course because otherwise you can develop resistant microbes in your body. It's one off the main reasons why the antibiotic resistant bacteria are spreading and developing so fast. !!!! Ask a legit doctor and he will say the same.

[antibiotics]

How do antibiotics work?  Antibiotics are commonly seen in the doctors’ prescriptions which always come in forms of tablets, capsules, liquids, and ointments. And they are very effective for the diseases caused by bacteria such as colds, coughs, sore throats and fever.
from okchem.com