The Brevity the Better: New Slogan for Prescribing Antibiotics
M3 India Newsdesk Feb 24, 2023
There has been considerable discussion over how long an antibiotic treatment should be, but new evidence suggests that shorter courses may be as beneficial as longer ones for many illnesses.
Key takeaways
- Overall, the research suggested that clinicians restrict antibiotic treatment duration to five days when treating patients with COPD exacerbations and acute uncomplicated bronchitis who exhibit clinical symptoms of bacterial infection.
- Antibiotics should be prescribed for CAP for a minimum of 5 days, and the length should be determined by clinically stable parameters;
- In women with simple bacterial cystitis, doctors recommend either nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days, or a single dose of Fosfomycin
- In both men and women with pyelonephritis, short-course antibiotics are acceptable depending on antimicrobial susceptibility (either 5 to 7 days of fluoroquinolones or 14 days of trimethoprim-sulfamethoxazole.
- Clinicians should provide an antibiotic treatment lasting 5 to 6 days to patients with nonpurulent cellulitis and closely monitor their progress.
Short-course antibiotic therapy
Short-course therapy is becoming the norm for the treatment of many illnesses, as shown by a recent position statement published by the American College of Physicians (ACP). According to the study, it takes 15–20 years for physicians to make changes in practice once conclusive data has been published. Reducing the length of time patients are on antibiotics, researchers say, helps curb the spread of resistant genes and prevents other potentially adverse consequences.
Evolving scenarios
The American College of Physicians (ACP) has released a position paper titled "Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice from the American College of Physicians" to urge prescribers to use shorter doses of antibiotics where necessary.
The necessity to reach general practitioners to give antibiotics in 10% of outpatient visits and are crucial to antimicrobial stewardship, was what first spurred the recommendations.
The infections discussed in the study make up a significant fraction of infections seen in both inpatient and outpatient settings, including pyelonephritis, cellulitis, community-acquired pneumonia (CAP), and bronchitis in patients with chronic obstructive pulmonary disease (COPD).
Nearly 30 randomised controlled studies comparing short- and long-course antibiotics for various diseases have been conducted in the last 25 years. Given the shifting body of data in favour of shorter courses, the ACP believed it was crucial to provide doctors direction.
Antibiotic treatment durations in the past were determined by clinical experience and case reports. Shorter courses are just as beneficial as longer courses, according to more than 120 RCTs for a range of diseases.
Advantages of shorter durations
Shorter durations are easier to administer and patients will feel more at ease with them as more doctors do so. Knowing the inclusion criteria for the research, as well as making sure the patient has the proper diagnosis and antibiotic prescribed for them, are prerequisites for translating these results into clinical practice. Instead of automatically switching to a lengthier course of antibiotics if a patient is not progressing on a regimen, it is crucial to reevaluate.
The significance of starting treatment early and using prescription techniques that result in "exactly the right quantity" of therapy should be emphasised once again. In order to prevent side effects and alterations to the beneficial microorganisms that are there, we are searching for that Optimum dose and duration of antibiotics that effectively cures the illness without overtreating it.
In regards to viral respiratory illnesses, this should be emphasised. We know that most colds are caused by viruses, and those drugs have no effect, so when a patient comes in and asks for an antibiotic as he/she has a cold. If we follow the new approach of a shorter course, they respond, "Well, my former doctor prescribed me 14 days of antibiotics. What makes this course shorter for me?" Such a clinical situation warrants a need for greater education on the efficacy and advantages of short-course antibiotics.
Determine the proper antibiotic course lengths for certain groups, such as immunocompromised individuals, since some may benefit from a short course of antibiotics while others may need a longer one. Clinicians need to be certain that using antibiotics for a shorter duration won't damage patients.
A shorter course of antibiotics may give frontline doctors more confidence since newer approaches for this research promise to combine not just clinical results but also patient-specific outcomes. For shorter periods of time, practitioners may feel more trust in the supplied data if they have strong patient connections and follow-up capabilities.
The way of thinking is pervasive
- Longer courses of antibiotic therapy and IV-only therapy for particular infectious syndromes were two examples of historical practises that have been "overturned" by the accumulation of modern studies that Spellberg and Lee worked on with colleagues in a paper that was published in Open Forum Infectious Diseases.
- These beliefs are founded on unreliable case studies from more than 50 years ago, which have been reinforced by the views of renowned experts.
- Contrarily, more than 120 recent randomised controlled studies have shown that treatment regimens with shorter durations are just as effective in treating many illnesses.
- Furthermore, for osteomyelitis, bacteremia, and endocarditis, oral antibiotic treatment has been shown to be at least as effective as IV-only therapy in 21 concordant randomised controlled studies.
- However, many clinical practitioners are still resistant to making these modifications. It is time for Infectious Diseases to fully enter the age of evidence-based medicine, leaving behind its tradition of eminent opinion-based medicine.
Conclusion
Because something has traditionally been done in a certain manner, prescribers must not stick to previous practices. The speciality of infectious diseases is excellently positioned to serve as a role model for trainees, for ourselves, and for our colleagues in other specialities if we can transcend our own impedances, both inherent and extrinsic. To achieve our common aim of enhancing medical care for patients, we should recognise that it is our duty to set an example. Our patients deserve nothing less from us.
Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.
About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.
-
Exclusive Write-ups & Webinars by KOLs
-
Daily Quiz by specialty -
Paid Market Research Surveys -
Case discussions, News & Journals' summaries
