Home · Health · Sep 21 archive
Antibiotics: When Less Is More
Developing
In Short: The American College of Physicians recommends shorter durations of antibiotics for common infections.
The American College of Physicians (ACP) updated its clinical guidelines in 2021, advocating for shorter durations of antibiotics for four common infections: community-acquired pneumonia, acute bronchitis with chronic obstructive pulmonary disease, urinary tract infections, and cellulitis.
He also noted the growing attention on the potential impact of antibiotics on the gut microbiome, although data on long-term effects are still lacking.
In some cases, such as early sinusitis, antibiotics may not be appropriate and can carry more risk than benefit.
Dr. Callahan called for further studies to determine if even shorter durations of antibiotics could be effective in the general population.
Dr. Cennimo highlighted the importance of preserving the microbiome and the need to determine how much clinicians can safely shorten antibiotic treatments.
Dr. Cifu's experience with a patient, Harrison, underscores the importance of accurate antibiotic prescribing.
When Harrison was initially overprescribed antibiotics, she felt overwhelmed, but gradually regained trust in her judgment after correcting the mistake.
The report also highlighted previous cuts to health programs that have reduced response capacity during critical times.
This perspective encourages empathy and the recognition that another person's suffering can make a claim upon us, even when it is inconvenient.
What this adds
The guidelines emphasize the importance of ensuring antibiotics are necessary before prescribing them, avoiding treatment of viral infections with antibacterials.
What's still developing
- “I now routinely discuss the potential harms of antibiotics on the gut microbiome with patients,” Callahan said.
- “When it comes to at-risk populations, such as those at higher risk for severe or recurrent infections, we need clarity on the appropriateness of shorter durations, and we should specifically define who is considered high-risk enough to warrant longer courses,” he said.
- “One of the most important factors is making sure the antibiotics are needed in the first place, for example, not treating viral upper respiratory infections with antibacterials,” he said.
- For each of these, the recommendations advise a maximum of 5 days of antibiotics in most cases, with extension only if needed.
- Other medical organizations have endorsed and highlighted the evidence for shorter courses of antibiotics in recent years as well.
- They also kill when health systems become overwhelmed, clinics empty, medicine supplies are disrupted, and people are too frightened or unable to seek care.
- When treatment is interrupted, health can deteriorate rapidly, leaving people vulnerable to opportunistic infections and more severe outcomes from other diseases.
- Cifu wrote a prescription for antibiotics and sent her home.
- “When we make mistakes, our accuracy doesn’t change — in fact, maybe our accuracy gets a little bit better because we’ve made a mistake,” Cifu said.
- “When he told me, I just felt like I was falling into a hole with no bottom,” Harrison said.
- When she went back to work, she gradually began to trust her judgment again.
- Yet there is a curious paradox at the heart of all this abundance: The more information we consume, the less time we seem to have to think.