Are standard antibiotic courses too long?

Shorter courses of antibiotics are nearly always as effective as longer ones for many common infections, according to Canberra infectious diseases physician and microbiologist Heather Wilson and co-authors, writing in the February edition of Australian Prescriber.

“Traditionally, the idea has been that prescribers should give a long enough course of an antibiotic to clear up an infection and prevent recurrence. However current scientific evidence doesn’t support this approach any more,” says Dr Wilson.

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

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 of antibiotics 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,” says Dr Wilson.

“For an acute sinus infection, a 5-day antibiotic course is as effective as a 6–10-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,” she says.

Read the full article.

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