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ACP Offers Guidance on Antibiotic Duration for Common Infections

WEDNESDAY, April 21, 2021 -- 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, M.D., M.S.P.H., 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 five 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 five 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 five days, trimethoprim-sulfamethoxazole (TMP-SMZ) for three 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 five- to six-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.

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