Advice from ACP supports short courses of antibiotics for several common infections

Because at least 30% of antibiotic use is considered unnecessary, best practices were issued on treatment of chronic obstructive pulmonary disease exacerbation and uncomplicated bronchitis, community-acquired pneumonia, uncomplicated urinary tract infection, and cellulitis.

ACP has issued Best Practice Advice with recommendations for the appropriate use of antibiotics for four common bacterial infections.

“Appropriate Use of Short Course Antibiotics in Common Infections: Best Practice Advice from the American College of Physicians” focuses on prescribing appropriate and short-duration antibiotics for patients presenting with four common infections. It was published April 6 by Annals of Internal Medicine.

The four Best Practice Advice items are as follows.

  • Chronic obstructive pulmonary disease (COPD) exacerbation and acute uncomplicated bronchitis. Clinicians should limit antibiotic treatment duration to five days when managing patients with exacerbations of chronic obstructive pulmonary disease and acute uncomplicated bronchitis who have clinical signs of a bacterial infection (presence of increased sputum purulence in addition to increased dyspnea and/or increased sputum volume).
  • Community-acquired pneumonia. Clinicians should prescribe antibiotics for a minimum of five days. Any extension of therapy should be guided by validated measures of clinical stability, which include resolution of vital sign abnormalities, ability to eat, and normal mentation.
  • Uncomplicated urinary tract infection. In women with uncomplicated bacterial cystitis, clinicians should prescribe short-course antibiotics, specifically nitrofurantoin for five days, trimethoprim-sulfamethoxazole for three days, or fosfomycin as a single dose. In men and women with uncomplicated pyelonephritis, clinicians should prescribe short-course therapy with fluoroquinolones (five to seven days) or trimethoprim-sulfamethoxazole (14 days) based on antibiotic susceptibility.
  • Cellulitis. In patients with nonpurulent cellulitis, clinicians should use a five- to six-day course of antibiotics active against streptococci, particularly for those who are able to self-monitor and have close follow-up with primary care.

“Clinicians, especially general internists, play a key role in antimicrobial stewardship, and quality improvement strategies can improve antimicrobial prescribing,” the paper stated. In the United States, at least 30% of antibiotics are considered unnecessary and treatment is often continued too long, it noted.