Should I fill my prescription?

October 12, 2006 9:09 AM

What will happen if I take 3 out of 10 ten days worth of antibiotics?

Will the 3 days worth be effective? My doctor gave me three days worth of samples and I'm undecided about filling the rest of the prescription (laziness and not feeling all that sick).

posted by rglass to Health & Fitness (26 answers total)

If 3 days worth were effective, I doubt he would have handed you a prescription for more. Call and ask for more samples.
posted by chiababe at 9:12 AM on October 12, 2006

IANAD but you really ought to take the full course prescribed. Not-feeling-sick doesn't mean you're cured. What you're thinking of doing contributes to the increase antibiotic-resistant bugs. Which is bad for all of us.

Is it really that big of a pain to take a pill?
posted by brain cloud at 9:14 AM on October 12, 2006 [1 favorite]

Well, by taking only 1/3 of your prescribed dose you can not only risk doing yourself little to no good in fighting off your bug, but you can also potentially contribute to the serious social problem of drug-resistant disease strains.

Google "antibiotic resistance patient noncompliance" for more information.

For your own sake and others, please take the full dose or nothing at all. To do otherwise isn't just lazy, it's unproductive and rather selfish.
posted by clever sheep at 9:15 AM on October 12, 2006

http://en.wikipedia.org/wiki/Antibiotics#Antibiotic_misuse

fill the perscription.

If you dont take the whole perscription, you'll kill off some of the germs. then the remaining ones are the badass take-no-shit-from no one germs. they make badass baby germs and then you've got yourself an antibiotic resistant infection for you and all your friends to enjoy.

(although almost no one ever remembers to take all 10. but 3 out of 10?)
posted by ZackTM at 9:16 AM on October 12, 2006

This is a terrible idea, both because it's unlikely to cure your infection and because in encourages the growth of antibiotic resistant germs that can make you and others sick.

Antibiotics are used to treat bacterial infections, and they work by helping your body attack bacteria. They work cumulatively, meaning that they help your body kill off the weakest germs first, and then the stronger ones as you get stronger. If you take only a few days worth of antibiotics instead of the entire prescribed course, what's likely to happen is that your body will fight off the weakest germs and leave the stronger ones to continue to breed.

If your body is strong, it may be able to clear the infection (although there's a chance that you could end up with a more serious infection that your body can't fight off, making you sicker than you were to begin with), but anyone else you've infected during that time will catch a stronger version of the bug that is somewhat resistant to the antibiotic you used. That means that they're likely to get sicker than you were and need stronger drugs to kill off the germs your body bred. This is why doctors always tell you to take the full course of antibiotics.

IANAD, but my understanding is that if you're not feeling very sick and want to take a chance, you're better off not taking the antibiotics at all than taking a shortened course of them.
posted by decathecting at 9:16 AM on October 12, 2006

Take a look at this prior posting, specifically the comment from IshamaelGraves.

If you don't take the rest of the prescribed antibiotic, you could be hurting not only yourself but anyone who catches the new resistant strain you might create.

(I don't think it's so much an issue of you personally not taking the full course of antibiotics-- but if lots of people don't, nasty bugs develop that are resistant). (IANAD, just a concerned passerby).
posted by nat at 9:21 AM on October 12, 2006

As a biomedical scientist, with decent knowledge of resistance mechanisms and such, I will tell you that these guys are right. Take the whole course of drugs or don't take them at all.
posted by chrisamiller at 9:30 AM on October 12, 2006

What everyone else said x10000. People not finishing off their full prescriptions can have very serious and grave repercussions on the rest of humanity. Please finish off the prescription.

As for as symptoms go, visual signs can be completely misleading. Just because you're not showing any ill effects does not mean the virus isn't alive and well inside your body. Just ask HIV carriers.
3 days isn't enough time to kill most infections. When a virus attacks your body to which you have immunity, it typically takes a couple days to completey dispatch of the invader. So, if it takes your immune system 2-3 days to kill something from which you don't even manifest symptoms, don't you think it'd take longer for a antibiotic to finish the job?

Also consider that your body doesn't gain any immunity from using antibiotics. Thus, if you don't finish the prescription and there is still a viable population, it will come back and full force. And guess what? The strand which remains is a survivor from the antibiotics.
posted by jmd82 at 9:38 AM on October 12, 2006

(jmd82 -- antibiotics don't kill viruses. only bacterial infections)
posted by brain cloud at 9:41 AM on October 12, 2006

It depends on what you have and how bad you have it. Of course I don't pretend to be a doctor. If you are taking the prescriptions for a life-threatening illness or major infection then you better not skimp.
posted by JJ86 at 9:42 AM on October 12, 2006

This is the image they gave us in pharmacy school:

The antibiotic is like a guy with a machine gun standing in a pitch-black room full of 1,000,000 bad guys, firing wildly. Say every clip of ammunition (every tablet) kills 90% of the villains.

So, after tablet #1, there are 900,000 dead bad guys and 100,000 left alive.

After tablet #2, 10,000 left alive

After #3, only 1,000 left alive.

So it's no wonder you feel better after 3 tablets. But the 1000 guys left are the wiliest and strongest ones. If antibiotic resistant bugs are going to develop, they will be decendants of those 1000. Also, to really get rid of the infection, you need to expend a LOT of ammunition on the last couple of bad guys.

Considerable research has been done on how many doses are necessary to really kill off an infection.

Nuke 'em from orbit, I say. Fill the prescription.
posted by selfmedicating at 9:45 AM on October 12, 2006 [9 favorites]

Crap, I always got that question wrong on the exams. Still the same effects =/
posted by jmd82 at 9:47 AM on October 12, 2006

In addition to the problem of encouraging resistant bugs to develop, three days may not be enough to get a therapeutic concentration of drug in your body. If the infection is in a tissue (not the bloodstream), it can take a while for the drug to "soak in" sufficiently.

The drug enters the blood at a certain rate after you swallow the pill. From there, it's a competition between how fast the drug can diffuse into your tissues and how fast your kidneys can filter it out. Usually, a drug will only diffuse into the tissues when there's a fairly high concentration in the blood. Sometimes the rate of excretion is so fast, there's not a high concentration of drug in your bloodstream for very long, so there's only a few hours in which the drug has any chance of getting into your tissues. By taking only 3 pills, you may not give yourself enough windows of opportunity for the drug to get into the tissues and build up to a high enough concentration in there to do anything.
posted by Quietgal at 9:56 AM on October 12, 2006

infections look like they're disappeared but they haven't. they retreat, to come back with a vengeance later

he's doctor, you're not. unless you have good reason to doubt his competence, take the entire prescription. infections are nasty
posted by matteo at 10:05 AM on October 12, 2006

Response by poster: Thanks, everyone, for your comments. You've convinced me to fill the prescription and take the entire course of antibiotics. I had no idea that not finishing antibiotics could potentially allow another person to acquire a stronger version of my infection.
posted by rglass at 10:09 AM on October 12, 2006

That's an awesome comment, selfmedicating. Great analogy.
posted by SeizeTheDay at 10:21 AM on October 12, 2006

If you take 3 days worth, you will start to get better, and then get much much much worse. Probably worse than you were to begin with.

Antibiotics are meant to be taken as prescribed. If it's a Z-pack of only 3 pills (the kind that work for 14 days AFTER you take them) that's different. But if you have a 2 or 3-time-a-day dosage and a whole bottle of pills, you better take them as listed.
posted by PetiePal at 10:27 AM on October 12, 2006

Take the entire course. Heed the advice of those above. It's a very very bad idea not to—because you'll be contributing to the development of resistant strains. Don't be a jerk to humanity.
posted by limeonaire at 10:29 AM on October 12, 2006

This is pendantic, and I appoligize, cool anology selfmedicating, but at 90% attrition rate per day, with 10 days to get to zero I think there has to be 10,000,000,000 bad guys in that room.

And may I also say, good username to answer this particular question.
posted by edgeways at 10:31 AM on October 12, 2006

I see you have already made the right choice, so this is mainly for the benefit of anyone else reading this thread. As a young teenager I did not understand the concept of antibiotic resistance, so I stopped taking some antibiotics once after a few days. BIG MISTAKE. The strep throat came back with a vengeance and it was really hard to kill it off. I was sick for a couple of weeks totally unnecessarily.

Don't screw around with this stuff.
posted by grouse at 10:35 AM on October 12, 2006

edgeways: the number of bacteria doesn't have to go down to zero from the action of the antibiotics alone. You immune system also has a dog in the fight, the antibiotics are reducing the bacterial load down to a small enough level that you are able to kill the rest with your own defense mechanisms. So don't worry so much about the numbers, either the 90% per day or the starting 1,000,000 or 10,000,000,000.
posted by peeedro at 11:15 AM on October 12, 2006

dasein, it is scary to think that people don't know about not taking the full course, but it's true. Maybe it's a combo of doctors and pharmacists not stressing the importance, and also a lack of public health awareness in general. If anybody has any info on which ARO (antibiotic resistant organisms) are on the rise, post 'em... Or maybe I'll just go find a biology listserv :)
posted by rmm at 11:24 AM on October 12, 2006

rmm:
Mike the Mad Biologist talks quite a bit about the latest news on resistant organisms. It'd probably be a good place to start.
posted by chrisamiller at 11:27 AM on October 12, 2006

One thing to note for the record is that this is one aspect of the "marketing" spend that people give pharmas a bad rap for. Things like teaching people about compliance are major health-care issues that also impact a pharma company's bottom line, and they spend a lot of money on bumping up both compliance and persistency rates.

This gets trashed under the banner of "they spend more on marketing than on research" but in fact even though it doesn't fall under research budgets, it is still clearly attached to health outcomes in society and for individual patients.
posted by mikel at 11:52 AM on October 12, 2006

Here's one more problem with not taking the full course: if you have a relatively run-of-the-mill infection, it's pretty likely that your PCP didn't actually culture the bacteria, but empirically gave you an antibiotic that covered the stuff that you are most likely to have. This is pretty common practice in primary care, and most of the time it doesn't cause problems. God forbid, though, that your infection develops into something more serious -- meningitis, pneumonia, sepsis, etc. Taking the three days of antibiotics can be enough to seriously screw up bacterial cultures -- three days (of most antibiotics) is not enough to wipe out the bacteria completely and keep you from getting sick, but it's enough to reduce the numbers of the bacteria to the point that they may not be apparent in fluid cultures). This means that treating you with the most effective, focused treatment will be seriously delayed if it's possible at all, since there won't be a way to find out exactly what is making you sick should that be necessary.

Anyway, I'm glad that you've decided to go the full course.

This is also one of the problems with the empiric treatment that is so rampant in outpatient care, but that's a rant for another day.
posted by LittleMissCranky at 12:41 PM on October 12, 2006

I'm an RN and want to throw in a big "bravo" for the excellent responses in this thread.
posted by puddinghead at 2:21 PM on October 12, 2006