By Amy Norton
HealthDay reporter
TUESDAY, April 6, 2021 (HealthDay News) – Millions of Americans have received a long course of antibiotics to treat a bacterial infection at some point in their lives. New recommendations from a large US medical group suggest that some of the most common bacterial infections can now be treated with shorter drug courses.
The advice of the American College of Physicians (ACP) states that for different types of infections, shorter antibiotic courses do the job – and are even safer to do so.
The conditions include simple cases of pneumonia, skin infection, and urinary tract infection (UTI), which means that they are not complicated by other conditions.
In general, according to the AKP, they can be treated with five to seven days of antibiotics or, in certain cases, even with three days instead of the conventional 10 days or longer.
Many patients are used to long courses, but their use has largely been based on “conventional wisdom,” said ACP President Dr. Jacqueline Fincher.
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In recent years, she said, clinical studies have shown that shorter courses are just as effective in “eradicating” many infections.
It’s also a safer approach, Fincher explained: shorter courses reduce the chances of side effects like nausea and diarrhea. They can also help fight the widespread problem of antibiotic resistance – bacteria exposed to an antibiotic mutate to thwart the drug.
Antibiotics, especially long courses, can also kill “good” bacteria that normally live in the body and help keep the various systems working properly, Fincher said.
Yeast infections, she noted, are an example of how this balance can be disrupted: When women take an antibiotic for a urinary tract infection, it can decrease the good bacteria that normally keep yeast growth in check.
A particular problem, according to Fincher, is potentially fatal intestinal infections caused by antibiotic-resistant C. difficile bacteria. These infections often occur after a person has received antibiotic treatment that destroyed many of the good bacteria in the gut.
The new ACP recommendations recommend shorter antibiotic courses for four infection groups:
- Acute bronchitis in people with chronic obstructive pulmonary disease. COPD is an umbrella term for two serious lung diseases: emphysema and chronic bronchitis. If COPD patients develop worsening symptoms (acute bronchitis) and the cause is likely a bacterial infection, the ACP recommends antibiotic treatment for a maximum of five days. (In previous advice, the ACP has said that people without COPD don’t need antibiotics for acute bronchitis – unless they may have pneumonia.)
- Lung infection. If people develop uncomplicated pneumonia, antibiotics should be given for at least five days and possibly longer depending on the symptoms.
- UTI. Treatment can often be five to seven days or even shorter. Women may be able to take the antibiotic combination trimethoprim-sulfamethoxazole 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 contain pus (like an abscess), it can be treated with antibiotics for five to six days.
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Fincher said the council is focusing on these four groups, in part because they are so common. But shorter courses might be suitable for other less serious infections as well, she added.
Some conditions will take longer courses, Fincher said – including “deep” infections like osteomyelitis, which causes inflammation of the bone. Longer treatment may also be better for certain patients, such as those with diabetes or a weakened immune system.
“Antibiotics can save lives, but like any drug, they have side effects,” said Dr. Helen Boucher, member of the Board of Directors of the Infectious Diseases Society of America.
First, it’s important for patients to be sure they really need an antibiotic, said Boucher, who also heads the infectious diseases division at Tufts Medical Center in Boston.
An estimated 30% of antibiotic prescriptions in the US are unnecessary, she found.
“Ask your doctor, ‘Do I really need this?'” Riet Boucher. The next question, she said, could be about duration: if the prescription is 10 days – the “default” for many doctors, the AKP says – patients can ask again why.
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Why are shorter courses now recommended? Only in the last few years have shorter and longer antibiotic treatments been tested in clinical studies, Boucher explained. (Drug companies don’t have much incentive to study less treatment, she noted.)
It was the problem of antibiotic resistance, Boucher said, that spurred researchers to see if shorter courses could be just as effective.
The recommendations were published in ACP’s Annals of Internal Medicine on April 6.
More information
The U.S. Centers for Disease Control and Prevention is more concerned with antibiotic resistance.
SOURCES: Jacqueline Fincher, MD, President, American College of Physicians, Philadelphia; Helen Boucher, MD, director of the Department of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, and member of the Board of Directors of the Infectious Diseases Society of America, Arlington, VA; Annals of Internal Medicine, April 6, 2021, online
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