We should shorten antibiotic duration

April 3, 2018

Why we should consider shortening antibiotic duration.

Can we achieve better outcomes when we use antibiotics to treat bacterial infections for longer duration in hospitals?

Perhaps not. And the evidence for whether longer duration is better than shorter duration is quite limited.

We evaluated the benefits and harms of shorter versus longer antibiotic therapy using data from published systematic reviews (1). We used the AMSTAR criteria (2) to assess the quality of included reviews, and GRADE criteria (3) to rate the quality of the body of the evidence.

We included six reviews with a total of 3,162 participants. Four reviews were of high quality, two of moderate quality. In adults, there was no difference in resolution rates between shorter versus longer duration antibiotics for peritonitis, ventilator-associated pneumonia, or acute pyelonephritis and septic UTI; the quality of the evidence was low to moderate. In children, there was no difference in resolution rates between shorter versus longer duration antibiotics for pneumonia, pyelonephritis, or confirmed bacterial meningitis; the quality of the evidence was also low to moderate.

Overall, we did did not have enough data to assess the effect of antibiotic duration on the development of new mono- or multi-drug resistance, or patient adherence to therapy. Furthermore, we did not identify any published reviews assessing several other conditions for which antibiotics are used in hospitals, e.g. muscular, and bone and soft tissue infections. Of note, and none of the included primary studies in the included reviews were conducted in low-income settings.

New (and updated) reviews assessing the effects of shorter versus longer duration should be conducted. There’s also now, a real need to conduct high quality clinical trials evaluating strategies to shorten the duration of antibiotics.

Igho J. Onakpoya is a Physician and Research Fellow at the Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford.

Competing interests: None declared

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