February 8, 2023
Healio reports on the debate over optimal antibiotic therapy duration, and citing research, relay that shorter durations are as effective as longer for many infections. Experts from various locations and organizations are included in the article. Leading off the argument is a quoted position paper from the American College of Physicians, the largest specialty society in the U.S., indicating shorter-course therapy is now standard of care for many infections.
One expert draws the source of the ‘shorter is better’ movement to a 2008 IDSA keynote lecture. That same expert claims it takes 15 to 20 years for doctors to change their practice following research, which puts the movement on such a timeline. Adjustments to antibiotic prescribing are underway and work to make this a lasting change continue.
According to one of the ACP position paper authors, the paper was published to provide guidance on several of the more common infections that were being treated with antibiotics. Those include COPD, CAP, pyelonephritis and cellulitis, among others and treatment recommendations around a five day course of antibiotics. A separate expert took the shorter is better mantra and examined data to affirm its application for cases of pneumonia, UTI, intra-abdominal infection, bacteremia, skin and soft tissue infection, bone and joint infection, pharyngitis, and sinusitis. That review found short-course antibiotic durations consistently resulted in similar treatment success rates as longer-courses.
These results, as well as other clinical trials, are being pushed out in literature. The application is getting picked up by clinicians, though some feel the data and mantra should be pushed harder in non-ID-related journals. However, it is pointed out that some studies have shown shorter is not better, meningitis, for example, and that an antibiotic approach should take into consideration the specific infection and assume a ‘just the right amount’ plan.
Shorter is better has taken a foothold in larger academic medical centers and is trickling down to nonacademic hospitals and clinics. Still, the experts caution prescribers be wary of dogmatic resistance and employing a treatment plan contrary to expectations, particularly in treating children whose parents have become accustomed to their pediatrician prescribing antibiotics. The article notes an expert saying infectious diseases is ideally positioned to model evidence-based antimicrobial prescribing for trainees, for each other, and for other specialties and to better the care provided to patients.
PIDS president Buddy Creech is among the experts quoted in the article. He shared, “I don’t know that we can make such a blanket statement that shorter is better, but we do know that we can say ‘just enough is better.’ As we learn more, I think what we’re realizing is that we can get more precise with how we treat. One size may not fit all, but that doesn’t mean that all the time shorter is better. We’re looking for that Goldilocks amount and duration of antibiotics that treats the infection but does not overtreat it so that we can avoid side effects and changes to the healthy germs that are there.”