Can antibiotics be stopped halfway through a course?

Can antibiotics be stopped halfway through a course?

This is a question I was asked recently and I realized that it is a question that comes up quite often among different families.
Why is it important to complete the entire course of antibiotics prescribed by your doctor? Are there times when the antibiotics can be stopped early?
A short but important topic.

Antibiotic treatment – when can the antibiotics be stopped early?

Well, we must learn to distinguish between different scenarios.
Bear with me.

Scenario number one – the physician prescribed antibiotics for an infection that was truly present

What do I mean? These are most of the cases we come across.
You visited your doctor and he/she determined that you or one of your children have an illness that must be treated with antibiotics for a certain number of days.
I don’t want to go into whether the doctor was right or wrong about the diagnosis, neither do I want to go into whether the length of treatment chosen was correct (did you know that nowadays the correct length of pneumonia therapy is only 5 days in children?). But let’s just say that the antibiotics were prescribed following an examination and thorough thought.
In these types of situations, the prescribed course must be fully completed.

Why is it important to complete the entire course of treatment that was prescribed by the doctor?

Behind every medical decision, stand solid academic facts that cause the doctor to make these decisions.
For example, in strep throat it is important to take antibiotics for ten days to try and eliminate the strep from the throat and to prevent rheumatic fever.
In ear infections in children, it is customary to treat for one week.
And so forth.
The concern with stopping antibiotics early is that a small/intermediate amount of bacteria will remain in our body, and as soon as we stop the antibiotics, they will thrive once again.
In addition, it is important to treat the infection as a collection of bacteria, and not just as one bacteria (sometimes they are the same type, but still slightly different from one another). It is likely that the antibiotics that were started will first destroy the more sensitive bacteria, while the other more resistant ones remain. Therefore, if we stop the antibiotics ahead of time we will remain with the more resistant and possibly more evil bacteria.
Would you like an example?
Imagine 10 to the power of 8 bacteria in every centimeter of a specific area in the lungs (pneumonia). After a day of antibiotics, there are 10 to the power of 6 left. After 3 days, 1000 are left, and so forth (the numbers are obviously not accurate but just go with the flow). If we stop the antibiotics before all the bacteria are destroyed, the remaining bacteria might get stronger, and the infection may return. The thought that our body can handle the remaining 100 bacteria per centimeter is always there, but the goal of treatment is to destroy them all.
In short, this isn’t good.

Second scenario, or, when can antibiotics be stopped early?

In very specific situations, when it is clear from the start that the antibiotics were not needed. Examples:
A person wakes up in the morning with fever and muscle pain and because he always receives Amoxicillin (or Azithromycin or whatever antibiotic it may be) when he visits the doctor with similar symptoms, he decides to take one tablet of antibiotics. In the afternoon, his wife comes home with a rapid flu kit and they discover that he has influenza. And let’s just not go into the whole issue of rapid tests, what kind of role they play and whether they are reliable (find out more in this link if you’d like), for now. It’s safe to assume that this person has one cause for his symptoms, and that is influenza. In such a scenario, when there was no reason to start the antibiotics in the first place, there is no reason to continue them either. It is even preferrable to stop taking the antibiotics in this situation.
Second example – sometimes when you see a doctor with a throat infection, a throat swab is taken, and the doctor starts you on antibiotics. But two days later the swab comes back negative. Provided the swab was taken correctly and the result is reliable, you can stop the antibiotic treatment because to begin with there was no reason to start it.
Do you get me?
There are endless examples – from the patient who thought they had a urinary tract infection but then the urine culture came back negative and to the misdiagnosis of the baby who had four days of fever and following the four days the fever resolved and a characteristic rash indicating roseola developed.
If you are finding it difficult to stop the course of antibiotics, or if you are worried, see your doctor, consult with them, and come to a joint decision.

In summary, this is a very short topic, but it is intuitive and important. It is not as advanced as one would imagine it were, but rather it is for sensible people that like to understand basic and simple medical thought processes. Remember, if you’re unsure – continue the antibiotics and see your doctor.
Hope I helped!

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