USA: Best Practice Advice on Short-Course Antibiotics

The American College of Physicians (ACP) has issued best practice advice for the appropriate use of short-course antibiotics in common infections. The guideline, published in the journal Annals of Internal Medicine, was released in the wake of earlier studies that have indicated that at least 30% of outpatient antibiotic prescriptions in the U.S. were "unnecessary" and "often continued for too long."

"Antimicrobial overuse is a major health care issue that contributes to antibiotic resistance. Such overuse includes unnecessarily long duration of antibiotic therapy in patients with common bacterial infections, such as acute bronchitis with chronic obstructive pulmonary disease (COPD) exacerbation, community-acquired pneumonia (CAP), urinary tract infections (UTIs), and cellulitis," wrote the authors.

"Some common bacterial infections are best treated with shorter courses of antibiotics, which will lessen the threat of resistant organisms," according to the authors.

Recommended Practices

The authors released the following practices based on a review of literature and published guidelines:

• Clinicians should limit antibiotic treatment duration to 5 days when managing patients with COPD exacerbations and acute uncomplicated bronchitis who have clinical signs of a bacterial infection (presence of increased sputum purulence in addition to increased dyspnea, and/or increased sputum volume).
• Clinicians should prescribe antibiotics for community-acquired pneumonia for a minimum of 5 days. Extension of therapy after 5 days of antibiotics should be guided by validated measures of clinical stability, which include resolution of vital sign abnormalities, ability to eat, and normal mentation.
• In women with uncomplicated bacterial cystitis, clinicians should prescribe short-course antibiotics with either nitrofurantoin for 5 days, trimethoprim–sulfamethoxazole (TMP–SMZ) for 3 days, or fosfomycin as a single dose. In men and women with uncomplicated pyelonephritis, clinicians should prescribe short-course therapy either with fluoroquinolones (5 to 7 days) or TMP–SMZ (14 days) based on antibiotic susceptibility.
• In patients with nonpurulent cellulitis, clinicians should use a 5- to 6-day course of antibiotics active against streptococci, particularly for patients able to self-monitor and who have close follow-up with primary care.

"Many physicians do not prescribe short-course therapy, frequently defaulting to 10-day courses, regardless of the condition," wrote the authors.

Reference

"Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians," is published in the journal Annals of Internal Medicine.

DOI: https://www.acpjournals.org/doi/10.7326/M20-7355