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A 2014 Discover Magazine article suggests that stopping a prescription of antibiotics earlier - when you feel healthy - may reduce the risk of antibiotic-reisstant bacteria spreading, rather than increasing it, as conventional wisdom would suggest (e.g. here or here).

An emerging view, however, suggests that standard long antibiotic courses are wrong on both counts — they’re no better than shorter courses and actually promote antibiotic resistance.

“The science is clear,” says infectious disease specialist Brad Spellberg of the Los Angeles Biomedical Research Institute. “Every study that has been done comparing longer versus shorter antibiotic therapy has found shorter therapy just as effective.” A few days of taking antibiotics, it seems, should usually be enough to knock infections on their heels, allowing the patient’s immune system to come in and mop up.

Which does the evidence point to?

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    "An emerging view" tends to be code for "we don't actually have any reputable proof, or anything that's stood up to peer review, but we want to make this sound more credible than it is." See also: Climate change denial; young-earth creationism; "intelligent" design.
    – Shadur
    Feb 2, 2016 at 10:24
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    Also, the reason you feel like crap when taking antibiotics is because they do nearly as nasty a job on your immune system as they do to the bugs that are affecting you; the theory behind the treatment is that your immune system can replenish itself after you stop killing it off with ABs but the bacteria that made you sick will be gone. If the latter made you sick while your immune system wasn't still reeling from an antibiotics treatment, what makes you think it'll do a better job now?
    – Shadur
    Feb 2, 2016 at 10:26
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    @Shadur I think you'll need to give some evidence for that claim; I would guess that the reason you feel like crap when taking antibiotics is because you're, you know, sick. Which is why you're taking the antibiotics.
    – Reinstate Monica -- notmaynard
    Feb 2, 2016 at 18:01
  • Are you asking about a short course of antibiotics, as prescribed by a doctor, or are you asking about a patient choosing to stop taking their antibiotic prescription before getting sign off from their physician? These are two different situations, where one is medically prescribed and one isn't.
    – user70848
    Feb 2, 2016 at 22:53

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Issue: Whether stopping a course of antibiotics earlier will increase the risk and spread of resistant disease causing bacteria in the body?

Evidence:

Traditional evidence pointed out that early stoppage of antibiotic intake decreases the chances of killing all bacteria causing infection and increases the risk of infection.

By taking the full course prescribed by your doctor, even if you start to feel better earlier, you increase the chances of killing all of the bacteria and reduce the risk of resistance.

Research later on found no significant differences was found between shorter duration of antibiotic treatment versus longer duration of antibiotic course through another study.

Currently, the latest evidence through research by Gwendolyn L Gilbert points out that premature end of therapy will not increase the risk of emerging resistance.

There is a common misconception that resistance will emerge if a prescribed antibiotic course is not completed. Premature cessation of antibiotic therapy will not increase the risk that resistance will emerge.

Gwendolyn L Gilbert concluded in 2015 that there is no risk in stopping an antibiotic course immediately and minimal risk if there is resolution of symptoms of mild infection.

There is no risk — and every advantage — in stopping a course of an antibiotic immediately a bacterial infection has been excluded or is unlikely; and minimal risk if signs and symptoms of a mild infection have resolved.

These findings for stopping antibiotics when there is substantial resolution of symptoms are applicable to a population who is unlikely to have a bacterial infection or those who have a self-limiting bacterial infection.

If an antibiotic is prescribed for a clear indication, and a minimum duration is supported by evidence-based guidance, patients should be advised not to stop treatment until the end of the course. For many other infections, where the optimal antibiotic treatment duration is less certain, the patient may be advised that it is acceptable to stop treatment when symptoms resolve.

Meaning:

  1. WHO's bottom line: Full prescription course of antibiotics must be taken irrespective of the length of course of antibiotics.

The bottom line is, your doctor should have had years of training and access to the latest evidence – so listen to them. Whatever the length of the course of antibiotics – take the full prescription.

  1. The practitioner is the final authority to educate and instruct the patient on when to stop the antibiotic course.

The decision to stop an antibiotic earlier than the agreed duration should ideally take place only after a follow-up discussion between the treating clinician (or designated clinical staff member, e.g. practice nurse) and the patient, to ensure that clinical features of infection have actually resolved and that there are no misunderstandings about the role of the antibiotic. This is also an opportunity to reinforce to the patient that the leftover antibiotic should be safely disposed of and not kept for future use or use by another family member.

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