Advances in infectious diseases
Editor – In his profound article Chris Ellis addresses what I too believe to be a myth, that ‘it is vital to complete the course of an antibiotic’ (Clin Med June 2009 pp 254–5). We are in good company as Harold Lambert, who was perhaps the most distinguished and wise infectious disease clinician of his generation, expressed this view in the Lancet in 1999.1 The reasons for believing that most courses are too long were discussed informally in Clinical Medicine in the same year.2 If the prevalence of bacterial resistance is directly related to population exposure to antibiotics and we are correct in our views, then to dispel this myth must be the surest and cheapest method of reducing the rate of development of bacterial resistance. A meta-analysis of the literature is unlikely to be helpful as most ‘short’ courses in published papers are themselves long in this context and stopping on recovery not allowed as an option. The studies needed to investigate this are fraught with potential problems. They are not commercially attractive and liable to ethical and indemnity issues because of the perceived risk of under-treatment. Nevertheless they need doing but for these reasons can only be undertaken on the direction of the Department of Health or large national or international societies with the support of their governments. Should we not be pressing for them now?
Footnotes
Please submit letters for the Editor's consideration within three weeks of receipt of the Journal. Letters should ideally be limited to 350 words, and sent by email to: Clinicalmedicine{at}rcplondon.ac.uk
- © 2009 Royal College of Physicians
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