American College of Physicians: Shorten antibiotic duration for these 4 bacterial infections

In an effort to combat antibiotic resistance, the American College of Physicians outlined best practices to shorten the duration of antibiotic prescriptions for several common bacterial infections in a report published April 6 in Annals of Internal Medicine.

The recommendations address the following bacterial infections: acute bronchitis with chronic obstructive pulmonary disease exacerbations, community-acquired pneumonia, urinary tract infections and cellulitis. 

Here is the guidance, as outlined in the report: 

  • For patients with COPD exacerbations and acute uncomplicated bronchitis who have clinical signs of a bacterial infection, antibiotic treatment duration should be limited to five days.
  • For patients with community-acquired pneumonia, antibiotic treatment should last a minimum of five days. After that, extending the use of antibiotics should be guided by validated measures of clinical stability, such as a return of normal vital signs and the ability to eat. 
  • For women with uncomplicated bacterial cystitis, antibiotic duration should last five days if treating with nitrofurantoin, three days with trimethoprim-sulfamethoxazole, or a single dose when treating with fosfomycin.
  • For men and women with uncomplicated pyelonephritis, clinicians should limit either fluoroquinolones to five to seven days, or trimethoprim-sulfamethoxazole for 14 days based on antibiotic susceptibility. 
  • For patients with nonpurulent cellulitis, prescribe a course of antibiotics active against streptococci for five to six days for those able to self-monitor and who can follow-up with primary care.

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