TUESDAY, April 6, 2021 (HealthDay News) – Millions of Americans have, at some point in their lives, been given a long course of antibiotics to treat a bacterial infection. But according to new recommendations from a large group of American doctors, some of the more common bacterial infections can now be treated with shorter treatments.
The advice, from the American College of Physicians (ACP), says that for several types of infections, shorter courses of antibiotics do the job – and even do it safer.
The conditions include simple cases of pneumonia, skin infection, and urinary tract infection (UTI), which means they are not complicated by other medical conditions.
In general, depending on the PCA, they can be managed with five to seven days of antibiotics, or even three days in some cases, instead of the traditional 10 days or more.
Many patients are accustomed to long-term treatments, but their use was largely based on “conventional wisdom,” said ACP President Dr Jacqueline Fincher.
In recent years, she said, clinical trials have shown that shorter treatments are just as effective in “eradicating” many infections.
It’s also a safer approach, Fincher explained: Shorter courses reduce the risk of side effects like nausea and diarrhea. They can also help fight the widespread problem of antibiotic resistance – where bacteria exposed to an antibiotic mutate in an attempt to thwart the drug.
Antibiotics, especially long-lasting treatments, can also kill the “good” bacteria that normally live in the body and help keep its various systems in good condition, Fincher said.
Yeast infections, she noted, are an example of how this balance can be upset: When women take an antibiotic for a UTI, it can decrease the good bacteria that normally control yeast growth.
Of particular concern, Fincher said, are life-threatening intestinal infections caused by antibiotic resistance. It’s hard bacteria. These infections often occur after a person has received antibiotics that have destroyed many good bacteria in the gut.
The new ACP recommendations recommend shorter antibiotic treatments for four groups of infection:
- Acute bronchitis in people with chronic obstructive pulmonary disease. COPD is a generic term for two serious lung conditions: emphysema and chronic bronchitis. When patients with COPD develop symptoms of worsening (acute bronchitis) and the cause is likely a bacterial infection, the ACP advises antibiotic treatment for up to five days. (In a previous opinion, the CPA said people without COPD do not need antibiotics for acute bronchitis – unless they have pneumonia.)
- Pneumonia. When people develop uncomplicated pneumonia, antibiotics should be given for at least five days, or longer depending on symptoms.
- UTI. Treatment can often last five to seven days, or even longer. Women may be able to take the trimethoprim-sulfamethoxazole antibiotic combination for three days, or a newer antibiotic called fosfomycin as a single dose.
- Cellulite. This is a common skin infection that often affects the limbs. As long as the infection does not involve pus (such as an abscess), it can be treated with antibiotics for five to six days.
Fincher said the advice focused on these four groups, in part, because they are so common. But shorter courses might also be appropriate for other, less serious infections, she added.
Some conditions will require even longer treatments, Fincher said – including “deep” infections like osteomyelitis, where there is inflammation of the bone. Longer treatment may also be better for some patients, such as those with diabetes or a weakened immune system, she noted.
“Antibiotics can save lives, but like any medicine, they have side effects,” said Dr. Helen Boucher, board member of the Infectious Diseases Society of America.
First, it’s important that patients are sure they really need an antibiotic, said Boucher, who also heads the infectious disease division at Tufts Medical Center in Boston.
It is estimated that 30% of antibiotic prescriptions in the United States are unnecessary, she noted.
“Ask your doctor, ‘Do I really need this? », Advised Boucher. The next question, she said, may be about duration: if the prescription is 10 days – the “default” for many doctors, according to the CPA – patients may again wonder why.
Why are shorter courses being advocated now? It’s only in recent years that clinical trials have started testing shorter rather than longer antibiotic treatments, Boucher explained. (Pharmaceutical companies have little incentive to study fewer treatments, she noted.)
It’s the issue of antibiotic resistance, Boucher said, which prompted researchers to see if shorter courses could be just as effective.
The recommendations were published on April 6 in the journal ACP Annals of Internal Medicine.
The US Centers for Disease Control and Prevention has more on antibiotic resistance.
SOURCES: Jacqueline Fincher, MD, president, American College of Physicians, Philadelphia; Helen Boucher, MD, division chief of geographic medicine and infectious diseases, Tufts Medical Center, Boston, and board member, Infectious Diseases Society of America, Arlington, Va .; Annals of Internal Medicine, April 6, 2021, online