Antibiotic Treatment of Common Infections

More Evidence to Support Shorter Durations

Benjamin J. Smith; George Heriot; Kirsty Buising

Disclosures

Curr Opin Infect Dis. 2020;33(6):433-440. 

In This Article

Conclusion

The optimal treatment duration for any infection will vary based on unique patient factors and the burden of disease. However, close follow-up and individualization of therapy is often impractical, particularly in the outpatient setting. Recommended durations are therefore selected to reliably cure the majority of individuals. Unfortunately, in many instances, these recommendations have been based more on tradition than rigorous evidence. Further, in our experience, these recommendations are often interpreted as a minimum duration even for patients with mild infection or rapid improvement. Finally, prescribing audits suggest that, in many instances, treatment is extended beyond these recommendations. Consequently, patients may be receiving antibiotic therapy far in excess of what is required.[49,50]

Here we have outlined recent evidence supporting shorter treatment courses for many common infections. We support efforts to expand this evidence base and optimize guideline recommendations. It is important to note that the shorter course regimens chosen for comparison here may themselves have limited scientific basis. Multiarm designs that estimate duration–response curves have been proposed as a way to better determine optimal treatment duration.[51] Additionally, efforts to clarify acceptable rates of relapse for common infections are also important.[52–54] Research into clinical decision-making tools and clinical parameters to individualize therapy may also help to avoid excess antibiotic use in patients with rapid response to treatment.[9,23,55]

We recognize that there must be room for clinical experience and judgement in the treatment of individual patients and that longer treatment duration may be appropriate in certain cases. However, for many uncomplicated infections, there is now compelling evidence that shorter course of antibiotics can be safely used. The research highlighted here should provide clinicians with confidence to opt for shorter durations of therapy in patients who are clinically improving.

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