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Antibiotics: When Less Is More
Developing
In Short: The American College of Physicians recommends shorter antibiotic courses for four common infections to reduce potential harm to the gut microbiome.
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 (CAP), acute bronchitis with chronic obstructive pulmonary disease (COPD), urinary tract infections (UTI), and cellulitis. The new guidelines suggest a maximum of 5 days of antibiotics in most cases, with extensions only if necessary.
Dr. Callahan, a spokesperson for the ACP, emphasized that the shift towards shorter antibiotic courses is not about patients stopping medication early but rather about clinicians prescribing more targeted treatment durations. 'This shift is about clinicians prescribing shorter durations of antibiotics, not patients arbitrarily discontinuing medication early,' Callahan said.
The potential impact of antibiotics on the gut microbiome is gaining more attention, although data on the long-term effects of antibiotic course length on the gut microbiome are still lacking. 'The growing body of data on the importance of the microbiome and the need to preserve it provides further impetus to determine how much clinicians can safely shorten needed antibiotics treatments,' said Dr. Cennimo.
In some cases, such as early sinusitis, antibiotics may not be appropriate and could carry more risks than benefits. 'In fact, in some cases, such as early sinusitis, antibiotics aren’t appropriate and carry much more risk than benefit,' Callahan noted.
The guidelines also highlight the importance of ensuring that antibiotics are necessary in the first place, avoiding the treatment of viral upper respiratory infections with antibacterials. '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,' Callahan said.
Other medical organizations have also endorsed and highlighted the evidence for shorter courses of antibiotics in recent years, aligning with the ACP's recommendations.
What this adds
The guidelines advise a maximum of 5 days of antibiotics in most cases, with extensions only if necessary.
What's still developing
- Studies are needed to determine whether even shorter durations of antibiotics than those currently recommended would work in the general population, said Callahan.
- “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.