For the last 20 years multi-resistant strains have changed the paradigm of in-hospital
antibiotic prescription, forcing physicians to prescribe more broad-spectrum antibiotics.
This selective pressure drives the emergence of new mechanisms of resistance, reducing
our therapeutic arsenal [
[1]
]. This concept has shifted of rational antibiotic prescription towards the duration
of antibiotic cycles [
- Gilbert G.
Knowing when to stop antibiotic therapy.
Med J Aus. 2015; https://doi.org/10.5694/mja14.01201
[2]
]. Both microbiological studies of bacterial population dynamics and studies regarding
mechanisms of acquired resistance appear to favor shorter durations of therapy [
[3]
,
[4]
]. In line with these findings, clinical trials published suggest the non-inferiority
of shorter cycles of antibiotics [
- Geli P.
- Laxminarayan R.
- Dunne M.
- Smith D.L.
‘One-size-fits-all’? Optimizing treatment duration for bacterial infections.
PLoS ONE. 2012; 7e29838https://doi.org/10.1371/journal.pone.0029838
5
,
6
,
7
]. It is therefore our conviction that this strategy is effective in shortening duration
of treatment, while achieving similar rates of clinical cure and minimizing emergence
of resistance.To read this article in full you will need to make a payment
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References
- Knowing when to stop antibiotic therapy.Med J Aus. 2015; https://doi.org/10.5694/mja14.01201
- Strategies for reduction in duration of antibiotic use in hospitalized patients.Clin Infect Dis. 2011; 52: 1232-1240
- The Maxwell Finland Lecture: for the duration-rational antibiotic administration in an era of antimicrobial resistance and Clostridium difficile.Clin Inf Dis. 2008; 46: 491-496
- ‘One-size-fits-all’? Optimizing treatment duration for bacterial infections.PLoS ONE. 2012; 7e29838https://doi.org/10.1371/journal.pone.0029838
- Pseudomonas aeruginosa bloodstream infection: importance of appropriate initial antimicrobial treatment.Antimicrob Agents Chemother. 2005; 49: 1306-1311
- Optimizing drug exposure to minimize selection of antibiotic resistance.Clin Infect Dis. 2007; 45: S129-136
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- Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: a randomised, double-blind, placebo-controlled study.Lancet. 2007; 369: 482-490
- The emergence of antibiotic resistance by mutation.Clin Microbiol Infect. 2007; 13: 5-18
- Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community acquired pneumonia: randomized, double blind study.BMJ. 2006; 332: 1355
- Duration of antibiotic treatment in community-acquired pneumonia — a multicenter randomized clinical trial.JAMA Intern Med. 2016; https://doi.org/10.1001/jamainternmed.2016.3633
Article info
Publication history
Published online: February 14, 2018
Accepted:
February 12,
2018
Received in revised form:
February 6,
2018
Received:
February 1,
2018
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
