Should I Finish This Course of Antibiotics?
You still occasionally see a meme describing the need to finish the course of antibiotics your doctor prescribes, or you will cause antimicrobial resistance.
The opposite is true. Since 30% of outpatient antibiotics are prescribed without indication, the shorter you poison your microbiome, the better. And it is more complicated than that, of course.
Should you finish the course of antibiotics? Yes, if it is appropriately prescribed for an indication in a sterile space.
Microbiome and Sterile Spaces
Antibiotics hurt your microbiomes but are necessary to eliminate pathogenic bacteria in sterile spaces. Often, long courses of antibiotics are indicated for serious infections in sensitive sterile spaces. If the infection is not in a sterile space, longer courses of antibiotics might cause more harm than good. This is because we always affect the microbiomes with any course of antibiotics, but we don’t always help the body get rid of the infection. Especially if the infection is viral. Many courses of antibiotics are prescribed for viral infections. Often, a Z-Pak is easier than talking to you.
If you don’t have a pathogenic bacteria in a sterile space, you might be better off stopping antibiotics when you feel better. Don’t take the entire course unless you have meningitis, otitis media, or other severe infections in sterile spaces.
Should I finish this course of antibiotics?
Your healthcare provider will hedge: complete the entire course of antibiotics prescribed. This is despite the evidence that shorter courses of antibiotics are often effective.
They cover their asses, and the incentive is to prescribe you a drug so that the visit can be coded for insurance purposes, and they can bill the visit as fast as possible because they have 35 other patients to bill after you. And if you are the 35th patient, you will get prescribed a Z-pak for your virus.
It is appropriate to stop antibiotics early if you don’t have a severe infection, you are otherwise healthy, and the antibiotic prescribed is for a non-descript (not specifically diagnosed serious condition) concern. Kids get 6-12 viral infections a year. How many viral infections do you think adults get?
When to complete the full course
Finish the course if you are sick or immunosuppressed.
If the infection is in a sterile space, finish the course of antibiotics.
I asked AI when you should finish a course of antibiotics, and it suggested:
- Severe or deep-seated infections (e.g., osteomyelitis, endocarditis)
- Infections where complete bacterial eradication is necessary (e.g., tuberculosis, strep throat in patients at risk for rheumatic fever)
This is an AI failure. Again, it is because of complexity. Osteomyelitis may affect 200 different bones; some need amputation, and some can be cured with oral antibiotics. Endocarditis has pretty good guidelines and mostly consists of IV antibiotics (which is not really what we are worried about when considering whether I should finish this course of antibiotics).
I love this: “Infections where complete bacterial eradication is necessary.” It’s so true! But the examples are TB and Strep in patients at risk for rheumatic fever! Who does that describe that lives in the USA? AI fail.
That passes for advice on stopping an antibiotic for a viral infection you don’t need.
Times to Stop Antibiotics
It is time to stop antibiotics when:
- you have a viral infection
- it hurts your microbiome more than it helps you survive a bacterial infection
- you feel better from an uncomplicated UTI, sinusitis, or any other infection in a non-sterile space where the indication for antibiotic prescription is weak
Should I Finish This Course of Antibiotics?
If 30% of antibiotics are prescribed unnecessarily, the answer is no. You shouldn’t finish your antibiotics unless there is a specific reason, such as the infection being in a sterile space, your weak immune system, or a nasty infection.
The real answer is that it is complicated and depends on your health, the indication, and whether the antibiotics will hurt you more than help you. Because it is complicated. You depend on your microbiome to keep you healthy. There are more bacteria in your gut than cells in your body. They outnumber us. And the gut has as many neuronal connections as the brain. It is complicated.
But unless you can find a good reason to keep taking antibiotics, the fact is most are overprescribed.