Doctors, not patients, should decide on best course of antibiotics

As a principal clinical pharmacist, I do not recommend that patients decide when to stop a course of antibiotics. Instead, the prescribing doctor should determine and prescribe the shortest possible course that achieves its purpose (Dangerous to take antibiotics for too long, by Dr Andrew Yam Kean Tuck , Aug 3; and Raise awareness on how antibiotics work, by Mr Francis Cheng, Aug 3).

Resistant bacteria have been shown to develop from inappropriate use of antibiotics, for example, when they are used to treat viral infections or non-infectious disease states, or when courses are prolonged when they are not indicated.

The Centres for Disease Control and Prevention in the United States has highlighted that 50 per cent of the world's outpatient antibiotic use is inappropriate or unnecessary.

Singapore's public restructured hospitals have antimicrobial stewardship programmes (ASP) comprising a team of infectious disease doctors and pharmacists, and supported by microbiologists.

The ASP team reviews the use of broad-spectrum antibiotics in inpatients for appropriateness 48 hours to 72 hours after antibiotic initiation. The team then recommends either to discontinue the course or use a targeted antibiotic that has similar efficacy in treating the infection. The ASP team also recommends an appropriate duration of antibiotic intake.

A British Medical Journal article, "The antibiotic course has had its day", reinforces these ASP principles that we operate on.

It is important to recognise that most of the commonly encountered respiratory tract infections are due to viruses, and antibiotics have no role in their treatment.

I also urge all prescribers to be prudent in using antibiotics.

Lee Siok Ying (Ms)

A version of this article appeared in the print edition of The Straits Times on August 14, 2017, with the headline 'Doctors, not patients, should decide on best course of antibiotics'. Print Edition | Subscribe