From the Guidelines
If you've missed days of your antibiotic course, you should resume taking the medication at your regular schedule and finish the entire course as originally prescribed, even if you feel better, to minimize the risk of antibiotic resistance and treatment failure. When missing doses, it's essential to contact your healthcare provider for guidance, as they may need to extend your prescription to ensure you receive the full treatment duration 1. According to the American College of Physicians, clinicians should prescribe antibiotics for a minimum duration, and extension of therapy should be guided by validated measures of clinical stability 1.
Some key points to consider when taking antibiotics include:
- Completing the full prescribed duration of treatment, even if symptoms have resolved
- Not doubling up on missed doses, but instead resuming the regular schedule
- Being aware that different antibiotics have different requirements, and some may be more critical to take consistently than others
- Understanding that missing doses early in treatment can be more concerning than later in the treatment course
- Taking antibiotics exactly as prescribed, with appropriate timing around meals if required
It's crucial to follow the prescribed antibiotic course to prevent antibiotic resistance, which is a significant public health concern, with an estimated 2.6 million illnesses and 35,900 deaths annually in the United States 1. By completing the full course of antibiotics as prescribed, patients can help minimize the risk of treatment failure and contribute to antimicrobial stewardship.
From the FDA Drug Label
When amoxicillin for oral suspension is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed Skipping doses or not completing the full course of therapy may: (1) decrease the effectiveness of the immediate treatment, and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by amoxicillin or other antibacterial drugs in the future. The answer to finishing an antibiotic course after missing days is to continue taking the medication as directed by your doctor. If you have missed days, you should not stop taking the medication, but rather continue with the prescribed course to ensure the infection is fully treated and to minimize the risk of antibiotic resistance. 2
From the Research
Antibiotic Course Duration
- The duration of antibiotic courses is a crucial aspect of treatment, with recent studies suggesting that shorter courses may be effective for certain infections 3, 4.
- A study published in the Journal of the Pediatric Infectious Diseases Society found that 5-day courses of antibiotics can be safe and effective for acute respiratory tract infections 3.
- Another study published in Current Opinion in Infectious Diseases summarized recent randomized controlled trials investigating antibiotic short courses for common infections in adult patients, demonstrating noninferiority of short-course therapy for several conditions 4.
Missing Days and Antibiotic Course Completion
- There is limited direct evidence on the specific topic of finishing an antibiotic course after missing days.
- However, a study published in Clinical Infectious Diseases found that shorter and longer courses of antibiotics had similar effectiveness in reducing infection-related complications, including hospital admissions 5.
- A systematic review published in JAC-Antimicrobial Resistance examined current evidence informing antibiotic duration for common bacterial infections and found that reducing antibiotic duration is a key stewardship intervention to mitigate antimicrobial resistance 6.
Considerations for Antibiotic Treatment
- The decision to finish an antibiotic course after missing days should be based on the individual patient's condition, the type of infection, and the specific antibiotic prescribed.
- Studies have shown that shorter antibiotic courses may be suitable for many bacterial infections, but more evidence is needed for severe infections and in low- and middle-income settings 6.
- Prescribers should consider the latest evidence and guidelines when making decisions about antibiotic treatment, including the potential benefits and risks of shorter or longer courses 3, 4, 6.