Bacteria Can’t Read Calendars
Physicians should stop a course of antibiotics once the infection has cleared, instead of using an arbitrary number of days.
I am constantly amazed at the standard practice of giving antibiotics for a predetermined number of days. We often prescribe a 7-day course or a 10-day course or a 14-day course. Sometimes, it’s just a 3-day course. Whatever it is, it seems that it has to be a relatively standard football score; an 8-day course simply won’t do.
Over the years, I’ve tried to find out where these numbers come from. The best I can determine is that it comes from the process of antibiotic approval by the Food and Drug Administration. A prospective controlled study must be done to compare a new drug for a particular infection with a drug that already has FDA approval. However, instead of comparing which drug cures patients faster or more effectively, cure rates are sought after a predetermined number of days of treatment. I suspect that is because it would be almost impossible for the pharmaceutical company to determine study costs with an uncertain duration of treatment. So when the study is completed and the drug is approved, its publication becomes the reference for physicians to use.
Unfortunately, the duration of treatment — that predefined and arbitrary number of days — is taken to be gospel, and physicians start using for their patient management, even though it was cooked up by some bean-counter in the pharmaceutical company.
We have data to suggest a better way. In a study analyzing 11 prospective controlled trials of antibiotic alternatives for the treatment of intra-abdominal infections, Dr. Harlan Stone demonstrated that the inflammatory signs (fever, elevated white blood cell count, presence of immature neutrophils) often used to identify the presence of an infection can also be used to identify its eradication.
It is amazing to realize that it would be a paradigm shift in medicine for doctors to act like doctors and not obey the therapeutic recommendations of accountants.
Medicine out of the Box 
Not sure I agree with this posting, although I enjoyed the last two I read in your blog.
I once had an infection I was prescribed antibiotics for. I missed work to go to the doctor and went back to work after I started taking my medication and was cleared as ” not contagious anymore”. I felt fine after two days. Day three, My doctors office calls… They say that my tests came back and my illness was viral so they asked me to stop taking the antibiotics because they didn’t want me on them if I didn’t need them .
So.. I stopped talking them. Two days later I became severely ill again and my boss actually asked me to leave work and go to the doctor again. I go back.. They say they messed up. It was a bacterial infection and I went back on antibiotics. After about a week, I was all better.
But in the meantime.. I lost my job. Because we had a ONE ABSENCE in the first year of employment clause.
Lesson I learned: Better to err on the side of caution because I can’t control antibiotics becoming useless from overuse, but I can’t afford not to take them because these days it could cost you a job.