A group of experts has a controversial position on the tax superbugs
But a group of experts on Infectious Diseases U. K. He asks doctors and health experts to change their pace. In a comment published in the British Medical Journal Wednesday, wrote: "The message" complete the event "has persisted despite not being supported by evidence and previous arguments that need to be replaced ... However, there are indications. That in many situations stop antibiotics before a safe and effective way is to reduce the excessive use of antibiotics. "
The authors Martin Llewelyn, Professor of Infectious Diseases at the Medical Faculty of Brighton and Sussex, and nine British colleagues suggest recent studies have shown shorter courses of certain classes of drugs such as quinolones are as effective as courses more recommended in the past ,
However, the authors are not only to provide further studies that could lead to shorter courses of treatment. They say that in the short term an "always complete the course" message needs to be emptied. "Research is necessary to determine the most appropriate alternative simple messages, how to stop when you feel better," they write. They say that there is not enough hard evidence to support the current guidelines, a situation that requires doctors to rely on assumptions or historical practice of the decision on the antibiotic treatment.
Experts resistance applaud proposals to reduce drug unnecessary consumption of medicines and improve the standard treatment protocols where possible. But they were skeptical about what the email change "change their pills" or significantly ambulant care change. "My thought is that this is a radical position, although a certain right way," says Lance Price, a biologist and director of the Antibiotic Resistance Action Center at George Washington University. "It [comment] is a good piece of thinking, but I think they are going too far to say that we must stop this email. We know that antibiotics are not intelligent bombs or hedges, are not just directed to a desired part of the body, such as the bladder as we would like, but say. "We will unlock this mail without a proper message provision and counter-action" is completely irresponsible. "
Lauri Hicks, director of the Office of Management Antibiotics at the CDC, said he agreed that there are many open questions about appropriate treatment of drug classes. But he warns that patients should not stop taking their antibiotics prescribed for themselves. "I recommend that if a patient feels better through a course of taking antibiotics, the patient or family should consult the attending physician to see if antibiotics stop safely," he said. "I really believe that a decision of the supplier input should be made. In some cases, the full course may be important, and for other milder infections may not be as important. "
Bacteria have developed several tactics to increase its strength, depending on the infection and involved antibiotics. Some tribes have learned to drive an antibiotic before they can cause damage. Others can effectively neutralize an antibiotic change in a way that renders them harmless. In some cases, the bacteria have mutated their external structures so that an antibiotic can not recognize them or join them, which makes it unnecessary to make medicines.
Longer cycles have the selective pressure of the antibiotic on the bacteria in the body, which can assist in the development of microbial resistance. As a result, infectious disease experts are trying to find a balance between ensuring that drugs are effective in removing harmful bacteria, keeping the processing time to minimum to eliminate infection required. The Infectious Diseases Society of America (IDSA) has changed some of its guidelines for some drugs, according to recent studies that show quite shorter courses. However, some studies show that the shorter course of treatment patients leave susceptible to a resurgence of infection or, in some cases, could lead to selective growth of resistant pathogens.
Existing recommendations to clinical trials are largely based, says Helen Boucher, Professor of Medicine and Infectious Diseases at the Tufts Medical Center and spokesman for IDSA. "I believe the spirit of this document is quite consistent that IDSA is defending," said Boucher. "As part of the strategy against the crisis of antibiotic resistance, we should think of strategies to reduce the use of drugs and drugs for a shorter duration. "The incentive to study these short courses must come from donors to come like the National Institutes of Health
Llewelyn and his co-authors propose some specific measures for the way forward. They wrote that a common practice in hospitals, a daily review of the need to get patients an antibiotic and become more frequent in primary care because it is where he wrote 85 percent of prescriptions. (Many experts, including Hicks, and said that this recommendation is due to the need, probably unrealistic, to pay post-examinations and time pressure of doctors and outpatients). The authors also call for fundamental changes in the drug treatment of public health and the announcement that "public education of antibiotics should emphasize the fact that antibiotic resistance is primarily the result of an excessive use of antibiotics and not a course". These major messaging changes are not yet ready for prime time, says Price.
Current guidelines do not recommend half-way medication treatment with a recommended treatment. For example, the CDC often said in their public documents and reports, "Take antibiotics exactly as prescribed by your doctor. Do not skip cans. Complete the treatment prescribed even if you start to feel better. "But the CDC and IDSA say that they keep reviewing the literature guidelines and support based on the new information.
Change the standard prescription practices will probably be a challenge, the authors recognize the comment, suggesting education "to stop their drugs" in schools UK "The idea that is deeply rooted, and doctors and patients are not currently in the Position consider a cycle of antibiotics, such as irresponsible behavior, "they write. Even the design of experiments has been difficult to test the current reduction of antibiotics, they added, because often the participants are asked to agree that recevoir antibiotics linkage on the basis that it could reduce the risk of antibiotic resistance. Risk. "
