Shorter antibiotic courses are becoming the norm—but that raises an important question we hear all the time:
Can patients stop antibiotics early once they start feeling better?
In this BONUS mailbag episode of Rumor vs Truth, we step outside our regular format to answer a single listener question submitted through our fan mail audio line. Hosts Don Weinberger, PharmD and Steve Small, PharmD revisit antimicrobial stewardship and bring back infectious‑diseases pharmacist Dr. Madeline King to break down what the evidence really tells us.
Together, they discuss:
- Why antibiotic durations have shortened over time
- Whether stopping early increases the risk of resistance
- Why “feeling better” doesn’t always mean the infection is resolved
- When stopping early might be reasonable—and why that decision should still come from the prescriber
- How pharmacists and clinicians can frame these conversations with patients
No CE credit is available for this bonus episode.
CE credit is available for our full episode on antimicrobial stewardship.
🎧 Related Episode (CE Available)
- Rumor vs Truth: Antimicrobial Stewardship
(Are we overusing antibiotics?)
🎧Listen: https://rumorvstruth.buzzsprout.com/episodes/19034041
▶️ Watch: https://youtu.be/L8m1g9Tq6Sw
TRC Healthcare Editor Hosts
- Steve Small, PharmD, BCPS, BCPPS, BCCCP, CNSC
- Don Weinberger, PharmD, PMSP
Guest
- Madeline King, PharmD, BCIDP
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Transcript:
Don Weinberger
Welcome to Boomer versus Truth. This is a bonus mailback episode where we answer one listener question outside of our regular full episodes.
Listener Question
Steve Small
And we’re dropping this as a separate bonus so our main episodes stay focused and clean. Uh and keep in mind, no CE is available for this episode.
Don Weinberger
Yep. And this one came through our send us fan mail audio option. So let’s hear from our listener.
Rumor vs Truth Listener
Love the show, first time caller. Real quick question, this might be low stakes, but would be interested to hear your thoughts. And that’s, you know, we keep shortening the duration of antibiotics from 10 to 7 to 5 to even three days in some cases. And at what point can patients or can patients just stop taking antibiotics when they start feeling better? Thank you.
Expert Insight
Steve Small
Well, that was cool getting to hear an audience member. But let’s walk through the practical answer here quickly and clearly. I was actually able to follow up with our episode guest, Dr. Madeline King, to get her thoughts on this. So let’s see what she had to say. Welcome back, Dr. King. Thank you for coming back to help us again with yet another claim regarding stewardship. Uh, one of our audience members asked, uh, does stopping antibiotics early uh when patients feel better, does that lead to resistance? What do you think about that?
Madeline King
Really good question. Um, thinking about stopping antibiotics early. So one of the reasons that we do shorter courses is that what we found and um studied over the past couple of decades is you know, shorter courses lead to less resistance because we’re not exposing all of the microbiome to antibiotics for a prolonged period of time. So in general, a shorter course is going to be better for the patient in terms of leading to resistance.
Steve Small
Yeah, that’s a great point. And I’m kind of curious, where then are all these durations we hear about coming from? Like how are we just throwing darts at a dartboard and seeing what sticks? Where are these, where, where do we get these ideas on durations?
Madeline King
Yeah, I I would love to say that they’re not entirely made up. Um, and if you go back to an article from uh Dr. Paul Sachs from like 2010, kind of a parody article, he talks about how we get five days from the number of fingers you have on one hand and seven days from the number of days in one week. Um, and it actually kind of feels like that’s where we got durations from. Um, and it may be where we started back when antibiotics were first being used 80 years ago. However, we do have a lot of actual evidence and literature over the past few decades that compares short to long courses of antibiotics. Um so we’ve used that literature to kind of base our guidelines on how to treat these infections, showing, you know, if five versus seven days you have no difference in outcomes, then we’re going to recommend five days in our guidelines.
Steve Small
Great. So we know that shorter courses have good outcomes, don’t lead to resistance, but longer durations don’t necessarily help with resistance, like we always used to be taught. Um, but what do we have to think about before we have patients maybe stop antibiotics when they’re feeling better? Any stipulations to think about there?
Madeline King
Yeah, that’s a great question. Um, you know, none of the guidelines on treating these infections say tell your patient if they feel better after three days to go ahead and stop. Um, because we’re not studying that. So we can’t say that that’s the right thing to do. Um, however, you know, if someone has a urinary tract infection and we give three to five days of antibiotics, um, if they’re feeling better in two to three days, should they stop? It’s probably fine. Um, should they call their provider and say, I’m feeling better, I’d like to stop a day early, that’s acceptable. But we all know it’s hard to get in touch with providers that quickly. Um, so I think it is really hard to tell patients, hey, stop as soon as you’re feeling better. Um, but what we really want to think about is what is the risk? So, what’s the risk of stopping early just because you feel better? Is the risk recurrence or is the risk that um, you know, the infection isn’t totally gone and symptoms are going to restart because it never actually went away? Um and we don’t really have anything supporting any of that. So I think for the most part, um, the best way to go is to educate providers on these shorter courses and let providers know, hey, you can really treat this infection with only five days of antibiotics instead of seven. Um and, you know, in certain cases, if they feel um very comfortable with the patient themselves and the infection they’re treating, they could tell the patient, hey, if you’re feeling better in a few days, go ahead and stop. I don’t know that this antibiotic needs to be continued for seven or ten days. Um, so I think it really should at this point still be coming from the provider to stop those antibiotics earlier than the duration that’s prescribed. Um, but we may get to a point where we feel comfortable saying, hey, as soon as you start feeling better, go ahead and stop.
Steve Small
Yeah, we’ll see what the research says. And regardless, it takes a patient-centered approach. I love that. Exactly. Thank you for describing that. And I’ll bring that back to Don and see what he thinks. But thanks again for all your help.
Madeline King
That’s great. Thanks for having me.
Steve Small
Glad we can have her back on the show for this. Uh, so the short takeaway is stopping early may be an option in some cases, but this decision should be up to the prescriber while talking with the patient. And patients should generally have completed at least the minimum duration here for a given infection, uh, such as three days instead of five for community acquired pneumonia.
Don Weinberger
Yeah. So thanks for listening to this bonus mailbag. Keep sending questions through the link in the show notes or email.
Steve Small
And we’ll be back with our next full episode on Gabapentin, C included, coming soon on May 19th. We’ll see you then.
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