4 new ACP advice statements for antibiotic use in India
M3 India Newsdesk Jun 03, 2021
The American College of Physicians has shared their best practices regarding the use of antibiotics for common bacterial illnesses in patients. This article throws light on how it is crucial and need of the hour to adopt these practices in India.
The ACP's best practice advice on the use of short-term antibiotics in common infections
Antibiotic resistance is exacerbated by antimicrobial misuse, which is a serious health concern. Antibiotics are overused in patients with common bacterial illnesses such as acute bronchitis with chronic obstructive pulmonary disease (COPD) exacerbation, community-acquired pneumonia (CAP), urinary tract infections (UTIs), and cellulitis for unduly extended periods of time. The best practices for providing effective and short-term antibiotic treatment for individuals with various illnesses are described in this article. The American College of Physicians has issued guidance titled 'Appropriate Use of Short-Course Antibiotics in Common Infections: American College of Physicians Best Practice Advice'.
Four best-practice advice statements by ACP
ACP has issued four particular best practice advice statements, each with brief remarks from the guidelines.
The justification for ACP antibiotic guidance: At least 30% of the 250 million antibiotic courses provided in 2014 were deemed unnecessary, and many of the regimens were excessively lengthy. Antibiotic-resistant infections are recognised as a "national threat" by both the ACP and the Centers for Disease Control and Prevention.
Appropriate antibiotic use has been defined by the ACP: Prescribe the appropriate antibiotic, at the appropriate dose, for the appropriate period, for a particular ailment. The goal of this best practice guideline is to indicate when shorter periods of antibiotic therapy are suitable for common bacterial illnesses observed in both inpatient and outpatient health care settings.
Best practice recommendation #1
COPD exacerbation and acute bronchitis:
When treating patients with COPD exacerbations or acute uncomplicated bronchitis who exhibit clinical symptoms of bacterial infection (increased sputum purulence in addition to increased dyspnoea and/or increased sputum volume), clinicians should restrict antibiotic therapy duration to five days.
Acute uncomplicated bronchitis is often self-limiting and viral in nature. The ACP does not suggest antibiotics until pneumonia is evident. Antibiotics are suggested for COPD due to the high pretest chance of bacterial causation. The Global Strategy for the Prevention, Diagnosis and Management of COPD (GOLD) recommendations advocate the use of antibiotics in the presence of clinical symptoms of bacterial infection. Antibiotic selection should be based on the most frequent infections.
Exacerbation of COPD treatment:
Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis are the most frequently reported bacterial pathogens. A combination of aminopenicillin and clavulanic acid, a macrolide, or tetracycline may be used to treat the infection.
Best practice recommendation #2
Community-acquired pneumonia:
Clinicians should administer antibiotics for a minimum of five days to treat community-acquired pneumonia (CAP). Extending antibiotic therapy beyond five days should be guided by proven clinical stability indicators, such as remission of vital sign abnormalities, capacity to eat, and normal mentation.
Empirical therapy should include both common infections, such as Streptococcus pneumoniae and Haemophilus influenzae, as well as atypical infections, such as Legionella species.
Shorter-duration antibiotic treatment is supported by evidence. Antibiotics for at least 5 days are recommended by the 2019 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) recommendation for the management of CAP.
Best practice recommendation #3
UTI- uncomplicated cystitis and pyelonephritis
Clinicians should provide short-course antibiotics to women with simple bacterial cystitis, such as nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole (TMP–SMZ) for 3 days, or fosfomycin as a single dose. Clinicians should recommend short-course treatment with fluoroquinolones (5–7 days) or TMP–SMZ (14 days) for men and women with uncomplicated pyelonephritis based on antibiotic susceptibility.
- UTI uncomplicated cystitis: Infectious cystitis is a typical reason for healthy women to take antibiotics. Use empirical antibiotics to target Escherichia coli, which accounts for more than 75% of all bacterial cystitis. Fluoroquinolones are quite efficient in 3-day regimens, but they have a significant risk of side effects; do not administer them indiscriminately. Save them for patients who have resistant pathogens.
- UTI pyelonephritis: The IDSA/European Society of Clinical Microbiology and Infectious Diseases (ESCMID) 2011 recommendations are the basis for the current treatment duration recommendation. There was no significant difference in clinical failure with fluoroquinolones in more recent data on shorter-course treatment.
Best practice recommendation #4
Cellulitis:
Clinicians should utilise a 5- to 6-day course of antibiotics active against streptococci in patients with non-purulent cellulitis, particularly in those who are able to self-monitor and have close follow-up with primary care.
Treatment recommendations: Cephalosporin, penicillin, or clindamycin, unless in individuals with further symptoms of MRSA, MRSA nasal colonisation, injectable drug usage, or systemic inflammatory reaction syndrome. Include an additional antimicrobial agent that is effective against MRSA and streptococci.
India- The centre of antimicrobial resistance catastrophe
Antibiotic abuse is widespread in India's private sector, particularly among children aged 0-4 years, new research showed. Inappropriate antibiotic prescription and usage is frequently the primary cause of antimicrobial resistance, which is an increasing problem not only in India but internationally. Antibiotic resistance is a worldwide problem.
However, India is the epicentre of this disaster. The country is affected by easy access to the strongest antibiotics without prescriptions or diagnoses by trained physicians, not only quacks who administer medications without consideration but by hospitals where abuse has resulted in the establishment of colonies of these superbugs. Excessive antibiotic use on living creatures and inadequate sanitation has created an ideal environment for these super-resistant microorganisms to pose a threat to our health. The American College of Physicians' best practice advice on the use of short-term antibiotics in common infections is the need of the hour for India.
Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.
The author is a practising super specialist from New Delhi.
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