Duration of Antibiotic Therapy: Shorter Is Better

Editorials6 August 2019Duration of Antibiotic Therapy: Shorter Is BetterBrad Spellberg, MD and Louis B. Rice, MDBrad Spellberg, MDLos Angeles County-University of Southern California Medical Center, Los Angeles, California (B.S.) and Louis B. Rice, MDRhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island (L.B.R.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-1509 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Society continues to face a crisis of antibiotic resistance, caused largely by the unabated overuse of antibiotics. The emergence of antibiotic resistance is the result of natural selection: Prescribing more antibiotics causes more selective pressure, which drives greater resistance. Thus, to decrease resistance, we need to prescribe fewer antibiotics.In 2008, one of us (L.B.R.) posited that of the different ways the medical community could reduce the amount of antibiotic treatment prescribed, the one that seemed safest and most achievable was to treat infections only for as long as necessary to achieve optimal cure rates (1). It is difficult and ...References1. Rice LB. The Maxwell Finland Lecture: For the duration—rational antibiotic administration in an era of antimicrobial resistance and Clostridium difficile. Clin Infect Dis. 2008;46:491-6. [PMID: 18194098] doi:10.1086/526535 CrossrefMedlineGoogle Scholar2. Spellberg B. The new antibiotic mantra—"shorter is better". JAMA Intern Med. 2016;176:1254-5. [PMID: 27455385] doi:10.1001/jamainternmed.2016.3646 CrossrefMedlineGoogle Scholar3. Wald-Dickler N, Spellberg B. Short course antibiotic therapy—replacing Constantine units with "shorter is better". Clin Infect Dis. 2019. [PMID: 30615129] doi:10.1093/cid/ciy1134 CrossrefMedlineGoogle Scholar4. Gjika E, Beaulieu JY, Vakalopoulos K, et al. Two weeks versus four weeks of antibiotic therapy after surgical drainage for native joint bacterial arthritis: a prospective, randomised, non-inferiority trial. Ann Rheum Dis. 2019. [PMID: 30992295] doi:10.1136/annrheumdis-2019-215116 CrossrefMedlineGoogle Scholar5. Royer S, DeMerle KM, Dickson RP, et al. Shorter versus longer courses of antibiotics for infection in hospitalized patients: a systematic review and meta-analysis. J Hosp Med. 2018;13:336-42. [PMID: 29370318] doi:10.12788/jhm.2905 CrossrefMedlineGoogle Scholar6. Hanretty AM, Gallagher JC. Shortened courses of antibiotics for bacterial infections: a systematic review of randomized controlled trials. Pharmacotherapy. 2018;38:674-87. [PMID: 29679383] doi:10.1002/phar.2118 CrossrefMedlineGoogle Scholar7. Pertel PE, Bernardo P, Fogarty C, et al. Effects of prior effective therapy on the efficacy of daptomycin and ceftriaxone for the treatment of community-acquired pneumonia. Clin Infect Dis. 2008;46:1142-51. [PMID: 18444848] doi:10.1086/533441 CrossrefMedlineGoogle Scholar8. Vaughn VM, Flanders SA, Snyder A, et al. Excess antibiotic treatment duration and adverse events in patients hospitalized with pneumonia. A multihospital cohort study. Ann Intern Med. 2019;171:153-63. doi:10.7326/M18-3640 LinkGoogle Scholar9. Spellberg B. The maturing antibiotic mantra: "shorter is still better". J Hosp Med. 2018;13:361. [PMID: 29370317] doi:10.12788/jhm.2904 CrossrefMedlineGoogle Scholar10. Fernandez-Lazaro CI, Brown KA, Langford BJ, et al. Late-career physicians prescribe longer courses of antibiotics. Clin Infect Dis. 2019. [PMID: 30615108] doi:10.1093/cid/ciy1130 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Los Angeles County-University of Southern California Medical Center, Los Angeles, California (B.S.)Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island (L.B.R.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1509.Corresponding Author: Brad Spellberg, MD, Los Angeles County–University of Southern California Medical Center, 2051 Marengo Street, C2K126, Los Angeles, CA 90033; e-mail, [email protected]lacounty.gov.Current Author Addresses: Dr. Spellberg: Los Angeles County–University of Southern California Medical Center, 2051 Marengo Street, C2K126, Los Angeles, CA 90033.Dr. Rice: Brown Medicine, 593 Eddy Street, JB 053, Providence, RI 02903.This article was published at Annals.org on 9 July 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoExcess Antibiotic Treatment Duration and Adverse Events in Patients Hospitalized With Pneumonia Valerie M. Vaughn , Scott A. Flanders , Ashley Snyder , Anna Conlon , Mary A.M. Rogers , Anurag N. Malani , Elizabeth McLaughlin , Sarah Bloemers , Arjun Srinivasan , Jerod Nagel , Scott Kaatz , Danielle Osterholzer , Rama Thyagarajan , Lama Hsaiky , Vineet Chopra , and Tejal N. Gandhi Annals On Call - Shorter-Duration Antibiotics for Community-Acquired Pneumonia Robert M. Centor and Brad Spellberg Metrics Cited byTreatment of erythema migrans with doxycycline for 7 days versus 14 days in Slovenia: a randomised open-label non-inferiority trialGuidelines for the management of male urinary tract infections in primary care: a lack of international consensus—a systematic review of the literatureThe Shorter Is Better movement: past, present, futureShorter antibiotic courses in the immunocompromised: the impossible dream?Use of biomarkers to individualize antimicrobial therapy duration: a narrative reviewCan the Future of ID Escape the Inertial Dogma of Its Past? The Exemplars of Shorter Is Better and Oral Is the New IVDuration of antibiotic treatment for Gram-negative bacteremia – Systematic review and individual participant data (IPD) meta-analysisHow to manage central venous catheter-related bloodstream infections due to Gram-negative bacilli?Antimicrobial treatment duration for uncomplicated bloodstream infections in critically ill children: a multicentre observational studyMachine learning and synthetic outcome estimation for individualised antimicrobial cessationAssessment of nationally recommended antibiotics for treatment of UTI in U.S.-Mexico border emergency departmentsAntimicrobial stewardshipShorter is better: The case for short antibiotic courses for common infections in solid organ transplant recipientsOutpatient and peri‐operative antibiotic stewardship in solid organ transplantationMultidisciplinary Collaboration for the Optimization of Antibiotic Prescription: Analysis of Clinical Cases of Pneumonia between Emergency, Internal Medicine, and Pharmacy ServicesCompliance to Guidelines in Prescribing Empirical Antibiotics for Individuals with Uncomplicated Urinary Tract Infection in a Primary Health Facility of Ghana, 2019–2021A review of recent advances in the treatment of adults with complicated urinary tract infectionEvolutionary History and Strength of Selection Determine the Rate of Antibiotic Resistance AdaptationClinical Impact of a Pharmacist-Driven Prospective Audit with Intervention and Feedback on the Treatment of Patients with Bloodstream InfectionHow to change the course: practical aspects of implementing shorter is betterAntibiotic treatment duration for bloodstream infections in critically ill children—A survey of pediatric infectious diseases and critical care clinicians for clinical equipoiseClinical Efficacy Protocol of Yinhuapinggan Granules: A Randomized, Double-Blind, Parallel, and Controlled Clinical Trial Program for the Intervention of Community-Acquired Drug-Resistant Bacterial Pneumonia as a Complementary TherapyPrevalence of Discordant Procalcitonin Use at an Academic Medical CenterA Desirability of Outcome Ranking Analysis of a Randomized Clinical Trial Comparing Seven Versus Fourteen Days of Antibiotics for Uncomplicated Gram-Negative Bloodstream InfectionDuration of Treatment for Pseudomonas aeruginosa Bacteremia: a Retrospective StudyUnraveling the Nature of Antibiotics: Is It a Cure or a New Hurdle to the Patient Treatment?Current international and national guidelines for managing skin and soft tissue infectionsOral Is the New IV. Challenging Decades of Blood and Bone Infection Dogma: A Systematic ReviewFive versus seven days of nitrofurantoin for urinary tract infections in women with diabetes: a retrospective cohort studyTargets and Methods to Improve Outpatient Antibiotic Prescribing for Pediatric PatientsExtending the Reach of Antimicrobial Stewardship to Pediatric PatientsAre short courses of antibiotic therapy as effective as standard courses for COPD exacerbations? A systematic review and meta-analysisAntibiotic Therapy for Respiratory InfectionStudy of the Drivers of Inappropriate Use of Antibiotics in Community Pharmacy: Request for Antibiotics Without a Prescription, Degree of Adherence to Treatment and Correct Recycling of Leftover TreatmentImpact of pharmacist-led services on antimicrobial stewardship programs: a meta-analysis on clinical outcomesSustained reductions in unnecessary antimicrobial administration and hospital Clostridioides difficile rates via stewardship in a nonacademic settingProposed metrics to benchmark antibiotic prescribing in pediatric outpatient settingsDuration of antibiotic therapy for Enterobacterales and Pseudomonas aeruginosa: a review of recent evidenceProspective trial of different antimicrobial treatment durations for presumptive canine urinary tract infectionsDuration of antibiotic therapy for common infectionsPopularization of "10"Effect of Antibiotic-Prescribing Feedback to High-Volume Primary Care Physicians on Number of Antibiotic PrescriptionsComparing success rates in central venous catheter salvage for catheter-related bloodstream infections in adult patients on home parenteral nutrition: a systematic review and meta-analysisA Physician-Driven Quality Improvement Stewardship Intervention Using Lean Six Sigma Improves Patient Care for Community-Acquired PneumoniaCharacterizing Risk Factors for Clostridioides difficile Infection among Hospitalized Patients with Community-Acquired PneumoniaPolicy Statement: Antibiotic Stewardship in PediatricsShort-Course Antimicrobial Therapy for Pediatric Community-Acquired PneumoniaRightsizing Treatment for Pneumonia in ChildrenOverview and Evaluation of Existing Guidelines for Rational Antimicrobial Use in Small-Animal Veterinary Practice in EuropeCAPPRIC Study—Characterization of Community-Acquired Pneumonia in Spanish Adults Managed in Primary Care SettingsAssociation of a Safety Program for Improving Antibiotic Use With Antibiotic Use and Hospital-Onset Clostridioides difficile Infection Rates Among US HospitalsDecision Tools and Studies to Improve the Diagnosis of Urinary Tract Infection in Nursing Home Residents: A Narrative ReviewPHarmacist Avoidance or Reductions in Medical Costs in CRITically Ill Adults: PHARM-CRIT StudyAntibiotic Stewardship in PediatricsMicrobiologic Failure Despite Clinical Cure in Pneumonia: Cum Hoc and Post Hoc Ergo Propter HocThe Role of Antibiotic Stewardship and Telemedicine in the Management of Multidrug-Resistant InfectionsShort- vs. Long-Course Antibiotic Treatment for Acute Streptococcal Pharyngitis: Systematic Review and Meta-Analysis of Randomized Controlled TrialsEfficacy and safety of subcutaneous administration of ceftazidime as a salvage therapy in geriatrics: a case reportAntimicrobial Treatment Duration in Sepsis and Serious InfectionsDrugs for Gram-Negative Bugs From 2010–2019: A Decade in ReviewComparative Effectiveness of Antibiotic Treatment Duration in Children With PyelonephritisWhat's Hot in Clinical Infectious Diseases? 2019 IDWeek SummaryCollaborative Antimicrobial Stewardship in the Emergency DepartmentNursing Home-Associated Pneumonia, Part II: Etiology and TreatmentUse of Antibiotics and Mortality in WomenAntimicrobial Therapy in the Context of the Damage-Response Framework: the Prospect of Optimizing Therapy by Reducing Host Damage 6 August 2019Volume 171, Issue 3Page: 210-211KeywordsAntibiotic resistanceAntibioticsBacteremiaDisclosureGram negative bacterial infectionsPneumoniaSkin infectionsTreatment guidelinesUrinary tract infectionsVentilator associated pneumonia ePublished: 9 July 2019 Issue Published: 6 August 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...