Duration of antibiotic therapy: shorter is better

Abstract

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 Pne