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Knowing when to stop antibiotic therapy

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To the Editor: The recent article by Gilbert usefully drew attention to the the harms that can arise from unnecessarily long courses of antibiotics.1 It was of particular interest that she highlighted the misconception that resistance will emerge if a course of treatment is not completed.

Australian health professionals commonly advise patients verbally to complete antibiotic courses, and professional guidance for pharmacists specifically recommends annotating dispensing labels with the words “until all used” or “until all taken”.2 This recommendation appears to be widely implemented based on our analysis of de-identified dispensing records collected as part of the PROMISe III trial.3

This dataset contains over 11 000 dispensings for the two most widely prescribed antibiotics in Australia, cephalexin and amoxycillin.4 Dispensing directions included a reference to completing the course in 87.9% and 91.7% of prescriptions for these two drugs, respectively.

The impact of advice to complete antibiotic courses is likely to be magnified in Australia by two further system factors, namely the poor alignment of pack sizes with clinically appropriate course durations and the widespread practice of prescribing antibiotics with repeat prescriptions.