April 05, 2021
2 min read
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Disclosure:
Fincher does not report any relevant financial information. Lee reports personal fees from ACP while conducting the study and personal fees from Prime Education and Medscape outside of the work submitted. In the guideline you will find all relevant financial information of all other authors.
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ACP cited previous data indicating that at least 30% of outpatient antibiotic prescriptions in the US were “unnecessary” and “often took too long,” and issued best practices for the appropriate use of antibiotics for multiple bacterial infections.
The guidelines recently published in the Annals of Internal Medicine discuss the “right antibiotic, the right dose, for the right duration” for uncomplicated bronchitis with COPD exacerbations, community-acquired pneumonia, UTIs, and cellulitis.
Reference: Lee RA et al. Ann Intern Med. 2021; doi: 10.7326 / M20-7355.
“This guide on the appropriate use of antibiotics is important for practicing physicians in treating these common conditions in our patients,” said the ACP President Jacqueline W. Fincher, MD, MACP, said in a press release. “With antibiotic resistance remaining a major concern in the US, it is of the utmost importance to train our clinicians to introduce shorter-term antibiotic therapy.”
Rachael A. Lee, MD, MSPH, A member of the ACP Scientific Medical Policy Committee and Associate Professor of Infectious Diseases and Internal Medicine at the University of Alabama in Birmingham and colleagues reviewed 38 articles consisting of published clinical guidelines, systematic reviews and individual studies to develop best practices Guidelines. Based on this rating, they recommend:
- Limiting the duration of antibiotic treatment to 5 days in patients with COPD exacerbations and acute uncomplicated bronchitis who show signs of bacterial infection, including increased sputum purity plus increased dyspnoea or volume;
- Treatment of community-acquired pneumonia with antibiotics for at least 5 days and extension of therapy based on “validated measures to measure clinical stability” such as the ability to eat and the resumption of normal vital functions and mental activity;
- For women with uncomplicated bacterial cystitis, prescribe either nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days, or a single dose of fosfomycin;
- Prescribe 5 to 7 days of fluoroquinolones or 14 days of trimethoprim-sulfamethoxazole, based on antibiotic sensitivity to men and women with uncomplicated pyelonephritis; and
- prescribe a 5- to 6-day regimen of antibiotics for strep streptococci in patients with non-purulent cellulitis, especially those who can self-monitor and are in close contact with their general practitioner.
The researchers found that clinicians often complete a standard 10-day course in antibiotics “regardless of the disease”. However, reducing treatment times has several benefits, they added.
“When clinically safe and supported by evidence, reducing the duration of antibiotic therapy decreases overall exposure to antibiotics, reduces selection pressures for resistant organisms, and decreases a patient’s risk of antibiotic side effects,” wrote Lee and colleagues.
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Kathryn A. Boling, MD
I do not necessarily disagree with the antibiotic use policy. However, there have been times when I’ve followed infection control guidelines such as: B. 3 days of antibiotics for an uncomplicated urinary tract infection or 5 days of antibiotics for bronchitis, but my patients were not fully treated with the shortened medication regimen.
So I’m a little hesitant to generally stop using antibiotics at some point. I would much rather make my own decisions based on what I know about the patient, their comorbidities, willingness to return for follow-up care, the likelihood of taking the prescribed medication, the severity and location of the infection, and finally, how they were treated and the result of previous infections.
While the published ACP directive on antibiotics or a directive on a specific issue is a good starting point, the directive should only be used as a guide, not as a rule.
Kathryn A. Boling, MD
Primary Care Provider, Mercy Personal Physicians, Lutherville, Md.
Disclosure: Boling does not report any relevant financial information.
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Helen W. Boucher, MD, FACP, FIDSA
With this guideline, the ACP guidelines have adopted previously published guidelines from the Infectious Diseases Society of America and a GOLD (Global Initiative for Chronic Obstructive Lung Disease) guideline, highlighting the fact that a shorter course of antibiotics is effective in all of these cases. So the main takeaway message here is that less is more. This is good news and supports the importance of good antimicrobial treatment.
Helen W. Boucher, MD, FACP, FIDSA
Treasurer, Board of Directors of the Society of America for Infectious Diseases
Head of Department of Geographic Medicine and Infectious Diseases, Tufts Medical Center
Director, Levy Center for Integrated Management of Antibiotic Resistance, Tufts Medical Center
Disclosure: Boucher reports to be the editor of the Sanford Guide to Antimicrobial Therapy.
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