Antibiotic treatment of common infections: more evidence to support shorter durations

Abstract

Purpose of review Although there is increasing recognition of the link between antibiotic overuse and antimicrobial resistance, clinician prescribing is often unnecessarily long and motivated by fear of clinical relapse. High-quality evidence supporting shorter treatment durations is needed to give clinicians confidence to change prescribing habits. Here we summarize recent randomized controlled trials investigating antibiotic short courses for common infections in adult patients. Recent findings Randomized trials in the last five years have demonstrated noninferiority of short-course therapy for a range of conditions including community acquired pneumonia, intraabdominal sepsis, gram-negative bacteraemia and vertebral osteomyelitis. Summary Treatment durations for many common infections have been based on expert opinion rather than randomized trials. There is now evidence to support shorter courses of antibiotic therapy for many conditions.

Antibiotic treatment duration for bloodstream infections in critically ill children—A survey of pediatric infectious diseases and critical care clinicians for clinical equipoise

“…This suggests that they recognize that shorter duration therapy could be appropriate for some patients, despite their current self-reported practices. We hypothesize that this dissonance exists because previous guidelines relating to antibiotic management of bacteremic syndromes endorsed these longer durations [ 18 , 19 ]; however, recent evidence has demonstrated that shorter-duration therapy is preferable for a number of different infectious syndromes [ 8 , 20 – 25 ]. In addition, earlier switch from intravenous to suitable oral antibiotics with patient defervescence and clinical improvement is another potential strategy to optimize treatment duration and reduce antimicrobial overuse [ 8 ].…”

Decalogue for the selection of oral antibiotics for lower respiratory tract infections

“…In the case of COPD treatment, both strategies are critical addition, shortening antibiotic time has other advantages such as better adherence, fewer adverse effects and lower cost [65]. Treating bacterial infections for only as long as necessary is probably the safest and most feasible means of reducing unnecessary antibiotic use [70]. The duration of antimicrobial treatment should be individualised and tailored to the clinical response of the patient [71].…”

Can we achieve shorter antibiotic courses in primary care?

“…3 Antibiotic treatment duration for many infections is typically based on convention rather than evidence, using arbitrary course lengths such as 7, 10 and 14 days with the main aim to avoid under treatment. 6 Some evidence for shorter courses for primary care indications is emerging, such as in community-acquired pneumonia, severe tonsillopharyngitis caused by group A streptococcus, and in acute bronchitis 6,7,8,910 Unfortunately, the evidence base for shorter courses of specific antibiotics for specific common infections remains sparse being composed of a limited number of clinical trials that have established non-inferiority of shorter regimens.…”