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Knowing when to stop antibiotic therapy

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In reply: Thompson and colleagues make an important point: contradicting dogma about the need to complete an antibiotic course is risky and potentially confusing.

My article1 was not written for patients, but it attracted media interest and public comment.2,3 I did not suggest that patients stop taking antibiotics as soon as they feel better, as some assumed2 — although I suspect many do.

Clearly whether they can do so safely, depends on the indication. It would be reasonable for a patient to ask, if the doctor has not explained, whether completing the course is necessary. If, as I suspect is still common, the antibiotic was prescribed for an acute respiratory infection, it is certainly sensible to stop when symptoms improve — albeit better not to have started.

Even when there is a good indication for taking antibiotics, pack sizes often do not correspond with recommended course durations,4 and both are often based on limited evidence. Shorter courses are likely to be just as effective for many infections.5 We need more evidence and more common sense, because unnecessary or unnecessarily long antibiotic courses promote resistance.