Antibiotic duration – a Goldilocks problem

Antibiotics save lives, but antibiotics can have negative effects.  When patients have bacterial infections, we want to treat them to prevent complications of the bacterial infection, but not treat them for an excessive duration.  So we have a Goldilocks problem – we want antibiotic duration to be just right – neither too short or too long. Some clinical conditions have adequate research to define the Goldilocks duration.  Community acquired pneumonia only requires 5 days of antibiotics, if the patient is clinically stable at 3 days.  We know that 5 days is sufficient, so if we give antibiotics for 7 or 10 days, the patient gets exposed to unnecessary antibiotics. Unfortunately this example is rather unusual.  We have learned antibiotic duration without the teaching (and guidelines) having an evidence base. So a new movement suggests that we should tell patients to stop the antibiotics when they feel better. The antibiotic course has had its day The concept of an antibiotic course ignores the fact that patients may respond differently to the same antibiotic, depending on diverse patient and disease factors. Currently, we largely ignore this fact and instead make indication specific recommendations for antibiotic duration that are based on poor evidence. This situation is changing in hospital practice, where biomarkers of treatment response such as procalcitonin can guide when to stop antibiotic treatment.30 Outside hospital, where repeated testing may not be ...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs