Antibiotics: Shorter Courses are Better.

As the excerpt below from The Prescriber’s Letter points out, the trend is toward shorter courses of antibiotics for common infections.  We have too long been following the old teaching of “complete the whole course of antibiotics” and 10-14 days being a useful number.  Not so!  (Except for strep throat, as noted below.)

From The Prescriber’s Letter (accessed 13 Nov 2016):

You’ll see more focus on using SHORTER courses of antibiotics.
We’re used to telling patients to finish the entire course of antibiotics, even if they feel better. And many of us were taught that longer courses are needed to prevent relapse and limit resistance.
Now more experts say shorter is better.
Longer courses are actually MORE likely to lead to resistance…partly by increasing our normal flora’s exposure to antibiotics.
Plus shorter courses often work as well for many infections.
We’ve already seen this shift. Up to 10 days used to be the norm for uncomplicated cystitis in women…but now we know that 3 days of TMP/SMX is usually enough.
Consider the type and severity of infection, antibiotic choice, and patient…and resist the urge to use longer courses “just in case.”
For example, feel comfortable using about 5 days of antibiotics for uncomplicated cellulitis or pyelonephritis…instead of 10 to 14 days.
For community-acquired pneumonia, it’s usually okay to stop antibiotics after just 5 days if the patient hasn’t had a fever for 2 to 3 days and is otherwise stable.
And 2 to 4 days is often all that’s needed to treat cystitis in most school-age without a fever…instead of the traditional 7 to 14 days.
If you’re on the fence, re-evaluate the patient’s symptoms in a few days. In many cases, it’s okay to stop therapy after symptoms improve.
 But for strep throat, continue to give a 10-day course of penicillin or amoxicillin…even if patients feel better. The full course is needed to eradicate the bug…and possibly prevent rheumatic fever.
Remind patients that antibiotics usually aren’t needed for bronchitis, sinusitis, pink eye, etc…since these are typically viral.

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