Expert Advice -- Is it Really Important to Finish Antibiotics?

Is it true that you can put yourself or your child in danger by not finishing prescribed antibiotics?

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ABOUT THE EXPERT

Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

I am so glad you asked this question. When it comes to finishing off a full course of antibiotics, most parents have difficulty. Certainly I have had trouble trying to remember to give (or take) all the doses on time for myself or my children when we have had an infection.

Most simple bacterial illnesses (strep throat, ear infections, etc.) respond relatively quickly to antibiotics. So, when you or your child starts feeling well after having been on antibiotics for a few of days, it's difficult to remember to finish the medication that has a whole week left.

However, seeing an antibiotic course to completion is one of the most important aspects of therapy for three very important reasons:

Not Enough to Kill the Infection If you don't finish the medication, all the bacteria causing the infection may not be killed. Then, the infection could come back in that same place or even show up somewhere else.

Resistance The best way to cause bacteria to become resistant to antibiotics is to undertreat them. Bacteria multiply very rapidly. As they multiply, random mistakes occur in their DNA which can make them resistant to antibiotics. The best way to keep this from happening in your child when she has an infection is to give all the doses on time. This will kill the bacteria rapidly and efficiently. When the bacteria are undertreated, some of them may have enough time to have these mistakes occur in their DNA. Then, when they multiply, you get a bunch of bacteria that no longer respond to the antibiotics.

Immune System Turns on You Some bacteria can make the immune system do things its not supposed to. A classic example of this is when strep throat causes Rheumatic Fever. The cause of this disease is not completely understood, but it is thought that there are parts of the body that have components that are chemically similar to the bug that causes strep throat, Group A Streptococcus bacteria. So, when the immune system begins fighting this bacteria, it confuses the body (particularly certain parts of the brain, joints, kidney, and heart) with the bacteria causing damage to those body parts. It takes a while for this process to occur, so it is common for the symptoms of acute rheumatic fever to show up weeks after the throat infection. However, it almost never occurs when the initial strep throat is completely treated with antibiotics. The funny part about strep throat is that the body will kill all the bacteria itself without antibiotics. The antibiotics just kill them off faster which is important to keep rheumatic fever from occurring. If all the medication isn't taken, the risk of getting rheumatic fever is higher.

Your concern about not finishing antibiotics is right on target. Therefore, let me offer a few things that can be done to help you as a parent remember to give all the medication on time?

• Many infections can be treated with one of several medications. Ask your doctor if he can prescribe something that is taken only once or twice per day. Fewer doses helps with successfully remembering them all.

• Ask if the medication has to be refrigerated. Many do not necessarily have to be, and having an antibiotic that is portable won't keep you from taking it because it was left at home.

• Make up a separate antibiotic calendar and post it in a prominent place in your home marking off each dose as you go.

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