Most Americans Still Believe Outdated Antibiotic Guidance, Study Finds
核心洞察
A survey of 1,475 U.S. adults found that nearly 90% believe it is always best to finish a full course of antibiotics (搜索), even when feeling better, reflecting outdated guidance.
About 60% of respondents preferred a longer antibiotic course for pneumonia (搜索), despite evidence that shorter courses are equally effective and safer.
A 2023 review of more than 120 randomized controlled trials found short antibiotic courses were as effective as long courses for infections ranging from UTIs to pneumonia (搜索).
A new study published in Open Forum Infectious Diseases finds that nearly 90% of Americans still believe it is always best to take the full course of prescribed antibiotics (搜索), even when they feel better—a belief consistent with long-running but now outdated public health campaigns. The findings highlight a significant gap between evolving medical evidence and public understanding of appropriate antibiotic course length.
The research team, led by Alistair Thorpe, PhD, research assistant professor of population health sciences at University of Utah Health, surveyed 1,475 people across the country about their attitudes toward antibiotic course length. Participants were asked whether they would feel more comfortable taking a three- to five-day course of antibiotics (搜索) for pneumonia (搜索), as recommended by current guidelines, or a course of a week or more, as recommended by outdated guidelines.
A Complex Reality
Despite evidence that shorter courses of antibiotics (搜索) are as effective and safer for pneumonia (搜索) than longer ones, about 60% of respondents said they would rather take the longer course. One of the main reasons people gave for preferring longer antibiotic courses was that they had been told to "always finish their antibiotic course"—88% of respondents had heard of, and agreed with, this common mantra. Most had been told this by their clinician, and many had also heard it via a public health campaign.
"Historically, there was very strong guidance by major health organizations and clinicians that you must always finish the course. Now, we're seeing a growing body of evidence saying that that is not always the case. And oftentimes, shorter durations of antibiotics (搜索) are as effective and safe as longer alternatives," said Thorpe.
The Evidence Behind Shorter Courses
A strong body of scientific evidence shows that, for many common infections, shorter courses of antibiotics (搜索) work as well as longer courses and are less likely to cause side effects. In 2023, infectious disease experts published a review looking back at 25 years of randomized controlled trials—more than 120 studies—investigating short and long courses of antibiotics. They found that short courses were just as effective as long courses for everything from routine urinary tract infections to more serious ailments like pneumonia (搜索).
The review also challenged the long-held assumption that longer courses are necessary to prevent antibiotic resistance. "That idea is rather based on urban legend," authors of an editorial appearing in Clinical Microbiology and Infection alongside the review wrote. "The longer patients and the environment are exposed to antibiotics (搜索), the greater the selective pressure driving resistance." In fact, shorter courses may actually decrease antibiotic resistance.
Still, there are some cases where longer courses remain most effective, such as tuberculosis (搜索).
Communicating Evolving Guidance
The study authors suggest that doctors and public health campaigns use several evidence-informed strategies to better communicate the complex reality of antibiotic course length—for instance, avoiding overly simplistic claims that either shorter or longer courses are universally better, and acknowledging that as scientific evidence accumulates over time, health recommendations can change.
Thorpe recommends that patients have an open conversation with their doctor about the appropriate course length and adherence plan. "Discuss with your clinician what the right duration is for you and when the right time is to stop your course," he said. "Getting advice directly from a clinician on a one-to-one basis about what is most appropriate for you in that situation is the right way to go."
Thorpe emphasized that the changing recommendations are a positive outcome of increasing knowledge. "Evidence is growing and guidance is evolving on antibiotic use, which is a normal process and a good sign that we are working to improve how we provide care," he said. "Our knowledge about how best to use antibiotics (搜索) has changed, but it has changed because we're learning more, and it's important that we make sure we are communicating this well to the public."