Antibiotics abridged - Unnecessarily long prescriptions may fuel drug resistance.

As I said, I don't see how a continuous LONGER single use term of antibiotics can possibly cause antibiotic resistance compared to a SHORT single use term. I can easily understand how the reverse is possible, though.

"The development of resistance may be reduced by avoiding subtherapeutic antibacterial exposure and prolonged treatment durations."

There was a reason that I used that sentence from that abstract to make the link in comment # 17.

These bugs are acquiring resistance all the time through spontaneous mutations, plasmid acquired genes, etc. especially under prolonged treatment whether it's from monthlong courses for bacterial endocarditis, osteomyelitis, really prolonged acne treatment or controversial Lyme disease recommendations. Thanks for the tip about azithromycin, but I can write my own scripts.

I agree with your assessment, especially because I find the headline misleading. It is one thing to administer IV antibiotics for three days, another entirely if the antibiotics are administered orally.

The general rule of thumb is two to three days after symptoms are gone, so no bacteria remain to cause relapse and become resistant to the antibiotic. Most prescriptions are of sufficient duration to accomplish this.

It has been my understanding that the resistant strains were the product of unfinished treatment i.e., people who quit taking the medication as soon as they felt better, not the product of taking the antibiotics for too long.

"These bugs are acquiring resistance all the time through spontaneous mutations, plasmid acquired genes, etc. especially under prolonged treatment whether it's from monthlong courses for bacterial endocarditis, osteomyelitis, really prolonged acne treatment or controversial Lyme disease recommendations."

Sorry, but I still don't believe that a long SINGLE CONTINUOUS COURSE can cause bacteria to develop antibiotic resistance. ALL bacteria acquire resistance through spontaneous mutations, acquired genes, etc. but please explain how they do so IF YOU'VE KILLED THEM ALL, and then continue the antibiotics in a continuous dose after they're all dead. The problem is FAR more likely from folks who DON'T actually take a single continous course, but "think they're recovered" but actually have NOT killed all the bugs, have symptoms flare up, and then re-start the antibiotics. Or doing stupid things like adding antibiotics to animal feed as a "preventative".

ALL bacteria acquire resistance through spontaneous mutations, acquired genes, etc. but please explain how they do so IF YOU'VE KILLED THEM ALL, and then continue the antibiotics in a continuous dose after they're all dead.

That's just it. Antibacterial antibiotics don't kill them all. They interfere with basic cellular processes. They have been divided into two main classes, bactericidal and bactertiostatic. Don't ask me who made or why this classification was made. I'm not a microbiologist.

Those that are in the beta lactam class, i.e. the penicillins and cephalosporins, inhibit bacterial cell wall synthesis, and they are usually called bactericidal, even though they are not killing the organism, just inhibiting the growth of cell walls of new bugs.

Most of the drugs mentioned on the previous acne link are bactertiostatic which inhibit protein synthesis at various ribosomes. Drugs like Cipro, in the class called flouroquinolones, inhibit DNA gyrase, the enzyme that bacteria need to uncoil its DNA prior to replication.

These drugs are not killing. They just inhibit basic functions needed to replicate. Literal killing is only done by a reasonably intact immune system.

"These drugs are not killing. They just inhibit basic functions needed to replicate. Literal killing is only done by a reasonably intact immune system."

Sorry, but this is a distinction without a difference. Since they can't replicate, they can't pass on any "acquired antibiotic resistance". Then they die. And yes, I know that antibiotics don't kill 100.000%, just knock the numbers down to a level where the immune system can handle the rest.

This STILL doesn't address the point that an UNINTERRUPTED DOSAGE SCHEDULE "longer than standard" should not increase the acquistion of antibiotic resistance.

From the article:

"...this can be of major importance in decreasing antibiotic consumption. On a population level there is a clear relation between total antibiotic consumption and resistance rates of the pathogens.6-8 Prolonged or repeated courses of antibiotics provide the selective pressure that favours the emergence of resistant isolates. Resistance rates among common respiratory pathogens for several antimicrobial agents are increasing.9 Decreasing the duration of antibiotic treatment in respiratory tract infection might therefore decrease resistance rates.

The article in no way addresses AT ALL the acquisition of antibiotic resistance on a "single patient" level.

And from your "follow-up" link:

"Notably, therapeutic exposure of bacteria to antibacterials exerts a continuous selection pressure on pathogens as well as on normal flora. This selection pressure may favor and/or enable resistance development through various mechanisms. The development of resistance may be reduced by avoiding subtherapeutic antibacterial exposure and prolonged treatment durations."

Likewise this statement doesn't define by what mechanism a "prolonged treatment duration" results in the acquisition of antibiotic resistance.

My contention is that a CONTINUOUS course of treatment is unlikely to so result, but that "prolonged treatment durations" allow an increased liklihood of DISCONTINUOUS treatment, which, I can easily see explaining any such population effects.

Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.