Dr. Aju Mathew presents top 3 updates on antibiotics
M3 India Newsdesk Aug 06, 2021
Historically speaking, antibiotics have been seen as miracle medicines worldwide. The duration of administering antibiotics is one of the very essential conditions in the overall recovery of patients. Here are 3 recent updates in the world of antibiotics from Dr Aju Mathew which gives us a comparative study and a broader re-evaluative perspective about the course of antibiotic prescriptions.
In clinical medicine, we try to do the least and achieve the best outcomes. Why is that the case? Everything we do is rooted in trade-offs: there are adverse effects to everything we do. Can we reduce the risks and achieve better outcomes? In other words, can doing less gives us more bang for our stuff? Less is more?
This week I was struck by a few trials that investigated a shorter course of antibiotic therapy to achieve similar outcomes as a longer course.
Shorter course of antibiotic therapy for men with uncomplicated UTI
In a randomised placebo-controlled, double-blind trial, investigators tested whether a 7-day course of ciprofloxacin or trimethoprim/sulfamethoxazole is non-inferior to a 14-day course for men with symptomatic UTI and have no fever. 
What did they find?
They found that complete resolution of symptoms occurred in a similar proportion of patients in the shorter course vs the longer course. Fewer patients had a recurrence of UTI when treated with the 7-day course. Overall, the study showed good outcomes with a lesser intensity of therapy. Less was more!
Prosthetic joint infection: How much antibiotics?
In this trial, an open-label randomised non-inferiority trial in patients with prosthetic joint infection and who have undergone debridement, a 6-week course was not non-inferior (yes, you read it right; it is a double negative) to a 12-week course.  Fewer patients in the longer course had a persistent infection within 2 years. There are some limitations that require further investigation.
Finding: More patients on the shorter course of antibiotics underwent debridement without undergoing implant exchange. In this case, less was not more.
Best practice of antibiotic use in common infections
Antibiotic resistance is an emerging global public health crisis. There are no two ways about it. One way to address is for the practitioners to be aware of the problem, study it, and prescribe rationally.
The American College of Physicians recently produced a guideline article that suggested best practices for common infections.
- For patients with COPD exacerbations and acute uncomplicated bronchitis, use antibiotics for only 5 days.
- For community-acquired pneumonia, use antibiotics for at least 5 days. Further use must be based on clinical assessment such as lack of improvement of vital signs, or clinical deterioration.
- For women with uncomplicated bacterial cystitis, use short-course antibiotics. For men or women with uncomplicated pyelonephritis, we should prescribe shorter courses based on antibiotic susceptibility.
- For non-purulent cellulitis, a short course of antibiotics active against streptococcus should be used.
I strongly recommend reviewing the full document which is open access.
A note from Dr. Aju Mathew
I hope this week’s journal review will stimulate you to think rationally about antibiotics use and prevent misuse. As I was writing this review, I received a call from a patient who has mild symptoms of COVID-19 and is on azithromycin. Why are we still prescribing it? Let me know your thoughts at email@example.com.
To read Dr. Aju Mathew's previous articles, click here: Dr Aju Mathew picks 3 clinical updates you should not miss & Dr. Aju Mathew lists 4 new updates in diabetes treatment
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Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.
Dr Aju Mathew is a medical oncologist, haematologist, internist and epidemiologist practising in Kochi.
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