Shorter Courses of Antibiotics May Sometimes Be Better in the Long Run – Nicole Leimbach – Nov 2016
For many years, prescribers have instructed patients to finish their entire course of antibiotics even after they start feeling better.
However, recent study results have shown that longer durations of antibiotics are not always beneficial.
The question many patients and prescribers are starting to ask is whether or not shorter courses are superior.
The idea behind finishing the full course of antibiotics was that it was thought to increase the chance of curing the infection, as well as decrease the risk of antibiotic resistance.
New study results, though, have shown that shorter course antibiotics are equally efficacious, and in some cases, may be preferred in certain disease processes.
It’s important to recognize that not all patients, nor all infections are to be treated equally.
Unless they are suffering from pain.
Then they are treated according to national standardized rules with no regard for individual differences.
Infection type, severity, potential for relapse, immune status, and antibiotic choice are all factors that should be considered prior to determining the duration of therapy
The following list details the duration of treatment and describes when shorter antibiotic courses may be appropriate.
- Many cases are viral and cannot be treated by antibiotics
- According to the Infectious Disease Society of America’s guidelines, the duration of treatment for bacterial infections should be 5 to 10 days
- A meta-analysis completed in Britain determined that a 5-day course is as effective as a 10-day course
Acute Otitis Media:
- Some cases are self-limiting and viral; therefore, recommend pain relievers such as acetaminophen
- Treatment guidelines vary from 5 to 10 days depending on age and severity
- Children <2 years of age, who’ve had recurrent infections, and who’ve had ruptured eardrums should receive 10 days of therapy
- Uncomplicated infections ≥2 years of age should receive 3 days or fewer
Uncomplicated Adult Urinary Tract Infections (UTI)4,5:
- 3-day courses are equally effective as 5- to 10-day treatment courses
- Encourage practitioners and patients to use trimethoprim/sulfamethoxazole for 3 days and nitrofurantoin for 5 days
- Note: patients with complicated UTIs, patients who are pregnant, and elderly patients will still require longer lasting courses
- Uncomplicated infections can be treated with a 5-day course versus a 10-day course
- Complicated infections or immunosuppressed should receive longer courses (typically 10 days or longer)
- Group A strep will require 10 days of amoxicillin/penicillin
- Alternative to 10-day oral treatment is a one-time intramuscular dose of benzathine penicillin G
- 10-day treatment with a first-generation cephalosporin for all patients except anaphylactic penicillin allergic patients
- 5 days of azithromycin in patients with an anaphylactic allergy to penicillin
- ****Note: strep throat should be treated with the appropriate antibiotic and for a longer duration to prevent complications such as rheumatic fever***
There are many benefits to using shorter courses of antibiotics.
By limiting the normal flora to antibiotic exposure, this lowers the risk of antibiotic resistance.
Shorter courses may be cheaper for some patients in addition to increasing the likelihood of adherence.
Due to a decreased exposure to antibiotics, the number of unwanted adverse effects is also lowered.
Author: Nicole Leimbach, PharmD, is a recent Texas Tech University Health Sciences Center School of Pharmacy graduate with emphasis in the areas of patient care and counseling. While in pharmacy school, she was the chairperson for numerous health fair events through the American Pharmacists Association. Her strong clinical pharmacy background combined with her history as a competitive and professional tennis player gives her unique perspective to help patients live healthier lives.