Advertisement

Shortening antibiotic duration for community acquired pneumonia

Published:February 14, 2018DOI:https://doi.org/10.1016/j.ejim.2018.02.013
      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 [
      • Gilbert G.
      Knowing when to stop antibiotic therapy.
      ]. This concept has shifted of rational antibiotic prescription towards the duration of antibiotic cycles [
      • Hayashi Y.
      • Paterson D.
      Strategies for reduction in duration of antibiotic use in hospitalized patients.
      ]. Both microbiological studies of bacterial population dynamics and studies regarding mechanisms of acquired resistance appear to favor shorter durations of therapy [
      • Rice Louis B.
      The Maxwell Finland Lecture: for the duration-rational antibiotic administration in an era of antimicrobial resistance and Clostridium difficile.
      ,
      • Geli P.
      • Laxminarayan R.
      • Dunne M.
      • Smith D.L.
      ‘One-size-fits-all’? Optimizing treatment duration for bacterial infections.
      ]. In line with these findings, clinical trials published suggest the non-inferiority of shorter cycles of antibiotics [
      • Micek S.T.
      • Lloyd A.E.
      • Ritchie D.J.
      • Reichley R.M.
      • Fraser V.J.
      • Kollef M.H.
      Pseudomonas aeruginosa bloodstream infection: importance of appropriate initial antimicrobial treatment.
      ,
      • Olofsson S.K.
      • Cars O.
      Optimizing drug exposure to minimize selection of antibiotic resistance.
      ,
      • Gustafsson I.
      • Sjolund M.
      • Torell E.
      • Johannesson M.
      • Engstrand L.
      • et al.
      Bacteria with increased mutation frequency and antibiotic resistance are enriched in the commensal flora of patients with high antibiotic usage.
      ]. 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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gilbert G.
        Knowing when to stop antibiotic therapy.
        Med J Aus. 2015; https://doi.org/10.5694/mja14.01201
        • Hayashi Y.
        • Paterson D.
        Strategies for reduction in duration of antibiotic use in hospitalized patients.
        Clin Infect Dis. 2011; 52: 1232-1240
        • Rice Louis B.
        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
        • 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
        • Micek S.T.
        • Lloyd A.E.
        • Ritchie D.J.
        • Reichley R.M.
        • Fraser V.J.
        • Kollef M.H.
        Pseudomonas aeruginosa bloodstream infection: importance of appropriate initial antimicrobial treatment.
        Antimicrob Agents Chemother. 2005; 49: 1306-1311
        • Olofsson S.K.
        • Cars O.
        Optimizing drug exposure to minimize selection of antibiotic resistance.
        Clin Infect Dis. 2007; 45: S129-136
        • Gustafsson I.
        • Sjolund M.
        • Torell E.
        • Johannesson M.
        • Engstrand L.
        • et al.
        Bacteria with increased mutation frequency and antibiotic resistance are enriched in the commensal flora of patients with high antibiotic usage.
        J Antimicrob Chemother. 2003; 52: 645-650
        • Malhotra-Kumar S.
        • Lammens C.
        • Coenen S.
        • Van Herck K.
        • Goossens H.
        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
        • Woodford N.
        • Ellington M.J.
        The emergence of antibiotic resistance by mutation.
        Clin Microbiol Infect. 2007; 13: 5-18
        • Moussaoui
        • Borgie
        • Broek
        • et al.
        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
        • Uranga Ane
        • et al.
        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