5, 7, 10 or 14 days: appropriate duration of treatment for bacteraemia or an example of ‘antimicrobial bingo’?

Riordan, Andrew

doi:10.1136/archdischild-2015-309132

Cited by 9 publications

(7 citation statements)

References 6 publications

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“…The preference for such durations has been observed previously in other settings and depended more on local practice and subspecialty than on clinical features such as fever, comorbidities, and severity. 51 52 53 In addition, for conditions where guidelines recommend longer durations, the percentage of prescriptions beyond the recommendation is substantially lower than for conditions where guidelines recommend a relatively short duration.…”

Section: Discussionmentioning

confidence: 99%

Duration of antibiotic treatment for common infections in English primary care: cross sectional analysis and comparison with guidelines

Pouwels

Hopkins

Llewelyn

et al. 2019

BMJ

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ObjectiveTo evaluate the duration of prescriptions for antibiotic treatment for common infections in English primary care and to compare this with guideline recommendations.DesignCross sectional study.SettingGeneral practices contributing to The Health Improvement Network database, 2013-15.Participants931 015 consultations that resulted in an antibiotic prescription for one of several indications: acute sinusitis, acute sore throat, acute cough and bronchitis, pneumonia, acute exacerbation of chronic obstructive pulmonary disease (COPD), acute otitis media, acute cystitis, acute prostatitis, pyelonephritis, cellulitis, impetigo, scarlet fever, and gastroenteritis.Main outcome measuresThe main outcomes were the percentage of antibiotic prescriptions with a duration exceeding the guideline recommendation and the total number of days beyond the recommended duration for each indication.ResultsThe most common reasons for antibiotics being prescribed were acute cough and bronchitis (386 972, 41.6% of the included consultations), acute sore throat (239 231, 25.7%), acute otitis media (83 054, 8.9%), and acute sinusitis (76 683, 8.2%). Antibiotic treatments for upper respiratory tract indications and acute cough and bronchitis accounted for more than two thirds of the total prescriptions considered, and 80% or more of these treatment courses exceeded guideline recommendations. Notable exceptions were acute sinusitis, where only 9.6% (95% confidence interval 9.4% to 9.9%) of prescriptions exceeded seven days and acute sore throat where only 2.1% (2.0% to 2.1%) exceeded 10 days (recent guidance recommends five days). More than half of the antibiotic prescriptions were for longer than guidelines recommend for acute cystitis among females (54.6%, 54.1% to 55.0%). The percentage of antibiotic prescriptions exceeding the recommended duration was lower for most non-respiratory infections. For the 931 015 included consultations resulting in antibiotic prescriptions, about 1.3 million days were beyond the durations recommended by guidelines.ConclusionFor most common infections treated in primary care, a substantial proportion of antibiotic prescriptions have durations exceeding those recommended in guidelines. Substantial reductions in antibiotic exposure can be accomplished by aligning antibiotic prescription durations with guidelines.

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Section: Discussionmentioning

confidence: 99%

Duration of antibiotic treatment for common infections in English primary care: cross sectional analysis and comparison with guidelines

Pouwels

Hopkins

Llewelyn

et al. 2019

BMJ

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“…In the case of Vignette 2, for example, a closer analysis of the participants’ choices demonstrated a bias towards the prescription of treatments with durations of either 5 or 7 days (or multiples thereof). This 5/7-day bias has previously been reported in the context of antibiotic prescribing 40 – 43 and is likely due to an inherent cultural tendency to use simple units of measurement (e.g., five fingers per hand and 7 days per week), which simultaneously serves as a memory aid. While the bias may not always present a problem, it could be particularly damaging in the cases of short-term bacterial infections, which can be treated successfully with only 2 or 3 days of medication.…”

Section: Discussionmentioning

confidence: 71%

Harnessing the wisdom of crowds can improve guideline compliance of antibiotic prescribers and support antimicrobial stewardship

Krockow

Kurvers

Herzog

et al. 2020

Sci Rep

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Antibiotic overprescribing is a global challenge contributing to rising levels of antibiotic resistance and mortality. We test a novel approach to antibiotic stewardship. Capitalising on the concept of “wisdom of crowds”, which states that a group’s collective judgement often outperforms the average individual, we test whether pooling treatment durations recommended by different prescribers can improve antibiotic prescribing. Using international survey data from 787 expert antibiotic prescribers, we run computer simulations to test the performance of the wisdom of crowds by comparing three data aggregation rules across different clinical cases and group sizes. We also identify patterns of prescribing bias in recommendations about antibiotic treatment durations to quantify current levels of overprescribing. Our results suggest that pooling the treatment recommendations (using the median) could improve guideline compliance in groups of three or more prescribers. Implications for antibiotic stewardship and the general improvement of medical decision making are discussed. Clinical applicability is likely to be greatest in the context of hospital ward rounds and larger, multidisciplinary team meetings, where complex patient cases are discussed and existing guidelines provide limited guidance.

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“…No se recomienda realizar urocultivo intra o post tratamiento, a menos que exista sintomatología urinaria posterior a 48 horas de iniciado el tratamiento o exista dudas en cuanto la adherencia a éste. En caso de ITU con bacteremia, se sugiere tratamiento antibiótico endovenoso por un mínimo de 5 días, hasta 24-48 h afebril, con mejoría clínica y adecuada tolerancia al antibiótico oral, y completar 10 días de tratamiento en total [18][19][20][21] .…”

Section: Alternativas De Tratamiento Antibiótico Empíricounclassified

Recomendaciones sobre diagnóstico, manejo y estudio de la infección del tracto urinario en pediatría. Rama de Nefrología de la Sociedad Chilena de Pediatría. Parte 1

J.¹,

O.²,

et al. 2020

Rev Chil Pediatr

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La infección del tracto urinario (ITU) es una de las infecciones bacterianas mas frecuentes en la edad pediátrica, pero su diagnóstico y manejo se pueden ver complicados por lo inespecífico de sus síntomas y signos de presentación, la dificultad en la interpretación de los exámenes, especialmente en niños mas pequeños, y por un pronóstico respecto a daño renal muchas veces incierto. En los últimos años, se ha evidenciado una modificación significativa en el enfoque diagnostico y terapéutico de esta patología, surgiendo la necesidad de actualizar las recomendaciones previas. El propósito de esta revisión es contribuir a reducir la variabilidad de la práctica clínica en el manejo de ITU en la población pediátrica, mejorando la detección y manejo de la patología estructural y otros factores de riesgo de daño renal, evitando acciones innecesarias en aquellos niños con bajo riesgo. En esta primera parte, se presentan las recomendaciones en cuanto a diagnóstico y manejo de la ITU en pediatría. En la segunda parte se detalla su estudio, prevención y seguimiento.

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5, 7, 10 or 14 days: appropriate duration of treatment for bacteraemia or an example of ‘antimicrobial bingo’?

Cited by 9 publications

References 6 publications

Duration of antibiotic treatment for common infections in English primary care: cross sectional analysis and comparison with guidelines

Duration of antibiotic treatment for common infections in English primary care: cross sectional analysis and comparison with guidelines

Harnessing the wisdom of crowds can improve guideline compliance of antibiotic prescribers and support antimicrobial stewardship

Recomendaciones sobre diagnóstico, manejo y estudio de la infección del tracto urinario en pediatría. Rama de Nefrología de la Sociedad Chilena de Pediatría. Parte 1

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