Shortened Courses of Antibiotics for Bacterial Infections: A Systematic Review of Randomized Controlled Trials

Abstract

Commonly prescribed durations of therapy for many, if not most, bacterial infections are not evidence-based. Misunderstandings by clinicians and patients alike influence perspectives on antibiotic use, including duration of therapy and its role in antibiotic resistance. To demonstrate that shorter durations of antibiotic therapy are as efficacious as longer durations for many infections, a systematic review was undertaken of English-language articles by using PubMed to identify articles for inclusion. Additionally, infection-specific guidelines were identified for review of recommendations. Search terms included specific infection types, randomized controlled trial (RCT), duration of therapy, treatment duration, short course, and long course. Only RCTs of single-agent antibiotic therapy for the treatment of bacterial infections in adults were included. Independent data extraction of articles was conducted by two authors by using predefined guidance for article inclusion. In total, 23 RCTs met our criteria for inclusion. All trials compared single-agent antibiotics for a short and long antibiotic course in six common infections: community-acquired pneumonia, ventilator-associated pneumonia, intraabdominal infections, skin and soft tissue infections, uncomplicated cystitis, and complicated cystitis or pyelonephritis. Clinicians can decrease net antibiotic use by recommending shorter courses where evidence supports them. Antimicrobial stewardship programs that systematically address treatment duration may significantly affect institutional antibiotic use without negatively affecting patient care.

Comparative Effectiveness of Antibiotic Treatment Duration in Children With Pyelonephritis

“…A possible explanation for the development of UTIs in healthy children less than aged 4 years is evolving elimination and hygiene practices during infancy and toilet training periods 1,[17][18][19] ; whereas children older than 14 years are more likely to experience UTIs related to sexual activity. 16,17 Children between these ages, however, the former. [7][8][9][10]22 It is postulated that higher failure rates with oral β-lactams are owing to a greater likelihood of persistent vaginal bacterial colonization after antibiotic treatment has been completed.…”

Use of Procalcitonin to Guide Discontinuation of Antimicrobial Therapy in Patients with Persistent Intra-Abdominal Collections: A Case Series

“…We found PCT to be a useful aid in the medical decisionmaking process to safely discontinue antimicrobial therapy in a series of patients with persistent intra-abdominal collections despite early drainage and an appropriate course of antimicrobial therapy. Patients with IAA often receive unnecessarily prolonged antimicrobial therapy which has been associated with a higher risk of complications including extra-abdominal infections, selection for resistant pathogens, and mortality [15,16]. However, many providers remain reluctant to discontinue antimicrobials in patients with persistent intra-abdominal fluid collections even in the setting of clinical improvement and downward trending or normal inflammatory markers [17,18].…”

Short antibiotic courses in community-acquired pneumonia in adults: less is better

“…Накопленные к настоящему времени свидетельства сопоставимой терапевтической эффективности коротких и длительных («традиционных») курсов АБТ бактериальных инфекций, в т. ч. и ВП [13,14], позволяют утверждать, что сокращение сроков приема антибиотика корреспондирует с уменьшением риска нежелательных лекарственных реакций, снижением вероятности селекции лекарственно-устойчивых штаммов возбудителей, повышением приверженности больного врачебным рекомендациям, делая лечение более экономичным [15][16][17]. Так, D. Guillemont и соавт.…”