HealthDay News — In a Best Practice Advice document issued by the American College of Physicians and published online April 6 in the Annals of Internal Medicine, recommendations are presented for prescribing appropriate and short-duration antibiotic therapy for patients with common bacterial infections.
Rachael A. Lee, MD, MSPH, from the University of Alabama at Birmingham, and colleagues conducted a narrative literature review of published clinical guidelines, systematic reviews, and individual studies that addressed common bacterial infections to describe best practices for appropriate and short-duration antibiotic therapy prescribing.
The researchers recommend limiting antibiotic treatment duration to 5 days when managing patients with chronic obstructive pulmonary disease exacerbations and acute uncomplicated bronchitis who have clinical signs of bacterial infection. For community-acquired pneumonia, clinicians should prescribe antibiotics for a minimum of 5 days; extension of therapy should be guided by validated measures of clinical stability, including resolution of vital sign abnormalities, ability to eat, and normal mentation. Clinicians should prescribe short-course antibiotics with either nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole (TMP-SMZ) for 3 days, or fosfomycin as a single dose in women with uncomplicated bacterial cystitis. Short-course therapy with fluoroquinolones or TMP-SMZ based on antibiotic susceptibility is recommended for women and men with uncomplicated pyelonephritis. A 5- to 6-day course of antibiotics active against streptococci is recommended for patients with nonpurulent cellulitis, especially those able to self-monitor, with 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 authors write.