Is it recommended to discontinue antibiotic therapy once initiated if it is deemed unnecessary?

From the Guidelines

It is generally not recommended to stop antibiotics once you've started them, even if they are not needed, as this can lead to bacterial resistance and other complications. You should complete the full course of antibiotics as prescribed by your healthcare provider. Stopping antibiotics prematurely can lead to bacterial resistance, where the surviving bacteria become harder to treat with the same antibiotics in the future. However, there are some exceptions to this rule. Recent research suggests that in certain cases, shorter courses of antibiotics may be appropriate, and sometimes a healthcare provider might advise discontinuing antibiotics if they determine they were unnecessarily prescribed 1.

Some key points to consider when deciding whether to stop antibiotics include:

• The type and severity of the infection being treated
• The patient's overall health and medical history
• The specific antibiotic being used and its potential side effects
• The risk of antibiotic resistance and other complications

If you believe you're taking antibiotics unnecessarily, don't stop them on your own - instead, consult with your healthcare provider. They can evaluate your specific situation and advise whether it's safe to discontinue the medication. This approach balances the risks of antibiotic overuse (which can lead to side effects like diarrhea, yeast infections, and disruption of beneficial gut bacteria) with the risks of undertreating bacterial infections 1.

In some cases, healthcare providers may use procalcitonin (PCT) levels to guide the discontinuation of antibiotic therapy, particularly in patients with hospital-acquired or ventilator-associated pneumonia 1. However, this approach is not universally recommended and should be individualized based on the patient's specific circumstances.

Ultimately, the decision to stop antibiotics should be made in consultation with a healthcare provider, taking into account the latest evidence and guidelines, such as those from the American College of Physicians and the Centers for Disease Control and Prevention 1.

From the FDA Drug Label

• Patients should be counseled that antibacterial drugs including ceftriaxone for injection should only be used to treat bacterial infections. • When ceftriaxone for injection 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 ceftriaxone for injection or other antibacterial drugs in the future.

It is not recommended to stop antibiotics once they’ve started if they are not needed, as this may lead to decreased effectiveness of treatment and increased likelihood of bacterial resistance. Patients should be counseled to complete the full course of therapy as directed by their physician 2.

From the Research

Stopping Antibiotics When Not Needed

• Stopping antibiotics when they are not needed is a way to reduce exposure to antibiotics and decrease the risks of antimicrobial resistance and antibiotic side effects 3.
• Shortening standard antibiotic courses and stopping antibiotics when patients feel better are two ways to achieve this, but many challenges need to be addressed before this approach can be considered evidence-based and implemented in practice 3.
• High-quality evidence supporting shorter treatment durations is needed to give clinicians confidence to change prescribing habits, and recent randomized controlled trials have demonstrated noninferiority of short-course therapy for a range of conditions 4.

Factors Influencing Prescriber Decision-Making

• Prescribers are more likely to continue antibiotics when discontinuation would conflict with local guidelines, when presenting symptoms clearly indicate antibiotics, and when patients have severe frailty or comorbidities 5.
• Prescribers are less likely to continue antibiotics when under no external pressure to continue, and decisions are also influenced by the risks to patient health of continuing or discontinuing antibiotic treatment 5.
• Guidelines that conflict with antibiotic discontinuation, such as those that pre-specify fixed durations, may discourage safe discontinuation at review, while guidelines conditional on patient factors or treatment response could help hospital prescribers discontinue antibiotics if diagnostic information suggests they are no longer needed 5.

Diagnosis and Treatment of Specific Infections

• For group A beta-hemolytic streptococcal pharyngitis, guidelines recommend using clinical decision rules to assess the risk of infection, followed by rapid antigen testing if a diagnosis is unclear, before prescribing antibiotics 6, 7.
• Penicillin and amoxicillin are first-line antibiotics for treating strep throat, with a recommended course of 10 days, but there is significant resistance to azithromycin and clarithromycin in some parts of the United States 6.
• Steroids are not recommended for symptomatic treatment, and patients with worsening symptoms after appropriate antibiotic initiation or with symptoms lasting 5 days after the start of treatment should be reevaluated 6.