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Clinical Question
Are short courses of antibiotics as effective as longer courses for common outpatient infections?
Bottom line
Just about every time someone asks "Can I get away with a shorter course of antibiotics," the answer is "Yes, you can." Shorter courses reduce cost, and may reduce the likelihood of adverse events. 1a
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Government
Setting: Various (meta-analysis)
Synopsis
This is a relatively new kind of study: a systematic review of systematic reviews, also called a systematic overview. The authors searched 5 databases and identified 9 systematic reviews that compared the duration of antibiotic therapies for a common outpatient infection. The reviews included between 2 studies and 17 studies, with a total of between 395 and 5763 patients. The best studied conditions were urinary tract infection (UTI), sinusitis, and community-acquired pneumonia (CAP). The authors found that, in children, 5 to 7 days was as good as 10 days for strep pharyngitis; 3 days was as good as 5 days for CAP; more than 2 days was as good as 7 or more days for otitis media, and 2 to 4 days was as good as 7 to 14 days for UTI. In adults, 3 to 7 days was as good as 6 to 10 days for acute bacterial sinusitis, 3 days was as good as 5 or more days for uncomplicated UTI in nonpregnant women, and 7 to 14 days was as good as 14 to 42 days for acute pyelonephritis. The authors also found that 7 or fewer days was as good as more than 7 days for CAP, and 3 to 6 days was as effective as 7 to 14 days for UTI in older women. There was some evidence that shorter courses resulted in fewer adverse events when treating acute otitis media in children and acute sinusitis in adults.
Reviewer
Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA
Comments
good poem
The 10 day antibiotic prescription exists in order to prevent rheumatic fever in those with a GAS infection.
Is this no longer true? It is not clear from this poem
What happened to the idea that incomplete course of antibiotics promotes bacterial resistance??
I tried the shorter treatment cycles in 10 consecutive patients, after getting informed consent , as this sounded like a great idea. Unfortunately in 3 of those cases, further treatment was required due to recurrence or recrudence of the infection.
this study sufficient to change guidelines ?
Praised be! (to quote my favourite saying from the Handmaiden's Tale) This is something I discuss with patients every day. Nice to see an overview that further supports this notion. Not sure I will be able to remember all the details in the POEM review but thinking of making a reference list for my own use! I love it when less is better.
Great news to go along with sometimes no antibiotics is best like in Otitis Media and Sinusitis
No evidence for reduced cost to patients
helpful meta-analysis for common outpatient complaints - will definitely help me alter my practice habits
Short Courses
Have the same question re Group A strep. Find myself using shorter for LRTI, Soft Tissue, Pyelitis.
Very good
Antibiotics reduce the bacterial load to where the immune system can finish the job. It's like sending special forces to help the local militia.