Standard antibiotics courses may be too long

Friday, 01 February, 2019

Standard antibiotics courses may be too long

We’re always told to finish a prescribed course of antibiotics no matter what, but now Australian researchers are claiming that shorter courses of antibiotics are nearly always as effective as longer ones for many common infections.

“Traditionally, the idea has been that prescribers should give a long enough course of an antibiotic to clear up an infection and prevent recurrence,” said infectious diseases physician and microbiologist Heather Wilson. “However, current scientific evidence doesn’t support this approach anymore.

“The more antibiotics are used, the greater the risk of adverse events, including resistance.”

In 2015, 30% of all patients attending a general practice received an antibiotic prescription, often in quantities several-fold more than recommended by Australian guidelines. Antibiotics don’t work for viral infections and even when the infection is bacterial, the benefits can be modest and outweighed by the harm from adverse effects. For instance, they are not necessary for many acute respiratory infections like sinusitis.

“It is important to tailor the antibiotic choice, dose and duration to the condition at hand,” Dr Wilson said.

“For an acute sinus infection, a five-day antibiotic course is as effective as a 6- to 10-day one.

“Similarly, shorter courses for acute otitis media, mild community-acquired pneumonia, acute uncomplicated urinary tract infection and others are recommended.

“Using antibiotics for the correct amount of time, even if it means not finishing a complete box, and not using unnecessary repeat scripts, can also reduce antibiotic use.”

Dr Wilson and co-authors have published their work in the journal Australian Prescriber. An accompanying editorial piece, published in the same journal, highlights the mismatch between recommended lengths of antibiotic treatments and pack sizes, and suggests regulations that require packaging antibiotics in accordance with clinical practice guidelines.

Image credit: © Komlen

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