August 27, 2026
Overview:
Antibiotic resistance is a growing global health challenge. One factor that can contribute to this problem is using antibiotics for longer than necessary.
In many low- and middle-income countries (LMICs), doctors work in settings where diagnostic tests may be limited, results can take time, and patients may have difficulty returning for follow-up care. These challenges can make longer antibiotic courses seem like the safer option, even when shorter courses may be appropriate.
This One Health Trust collaborative article explores why shorter antibiotic courses, which can be effective for many uncomplicated infections, are not widely used in LMICs.
The Question:
Why are shorter antibiotic courses, which evidence suggests can be effective for many uncomplicated infections, not widely used in LMICs?
The Findings:
The authors looked beyond individual prescribing decisions to consider the wider challenges doctors face, including uncertainty about a patient’s diagnosis, treatment outcomes, and whether the patient will be able to return for follow-up.
The authors argue that longer antibiotic courses should not simply be viewed as poor prescribing or a failure of antibiotic stewardship.
In many settings, doctors may prescribe antibiotics for longer courses because they are working with limited diagnostic resources, high patient volumes, and concerns about treatment failure or follow-up. Longer treatment can provide reassurance when there is uncertainty, but unnecessary antibiotic exposure can also contribute to antibiotic resistance and other issues.
The authors conclude that addressing this problem requires more than asking doctors to prescribe differently. Health systems also need to reduce the uncertainty doctors face by improving access to diagnostics, strengthening healthcare services, supporting evidence-based guidelines, and providing appropriate training.
Tackling antibiotic resistance requires approaches that consider both the needs of individual patients and the health of the wider population.
Read the commentary in the American Journal of Bioethics here.
