Shortening Antibiotic Treatment Duration to Fight Antibiotic Resistance

By the bioMérieux Connection Editors

Using the right antibiotic at the right dose and the right duration is critical in the fight against antimicrobial resistance.  Although there is a large amount of data available on prescribing practices in inpatient settings, a 2018 study noted that more data are needed from outpatient settings. The authors of that study found that in 14% of cases, the right antibiotic was prescribed, but the treatment duration did not follow guidelines.  Additional findings led the authors to conclude that, “there is an enormous opportunity to reduce inappropriate outpatient antibiotic prescriptions.”

Historically, general practitioners have prescribed treatment with the idea that antibiotic prescriptions should be long enough to minimize failures and avoid undertreatment, according to the World Health Organization. Additionally, the emergence of resistance has been frequently associated with suboptimal dosing. However, evidence now suggests that antibiotics affect the abundance of antibiotic resistance genes in commensal bacteria, which can be a potential reservoir for pathogenic bacteria becoming more resistant. In general, the longer the exposure to an antibiotic, the higher the risk of developing an antibiotic resistant infection.

Reducing the Risks of Antibiotic Side Effects

Overuse of antibiotics not only perpetuates antibiotic resistance, but it also puts patients at risk for side effects. Common side effects can include diarrhea, rash, and yeast infections (candidiasis). Accumulated exposure to antibiotics has been shown to increase the risk of developing a Clostridioides difficile infection, emphasizing the need to reduce the length of treatment where possible.  Less common side effects are possible as well, and some are quite serious. For example, the US Food and Drug Administration recently expanded on its warning about fluoroquinolones, stating that they may cause aortic aneurysm in certain patients.

Evidence from controlled trials and meta-analyses suggest that reduced antibiotic treatment durations may clear infection with similar efficacy to longer treatments, while minimizing selection, proliferation, and growth of antibiotic-resistant bacteria and the possibility of overuse side effects.

Antibiotic Resistance and COVID-19

Secondary bacterial infections often complicate viral infections, and historically, have contributed to mortality in past pandemics.  According to an article in Scientific American, “During the 2009 H1N1 influenza pandemic, environmental microbiologists warned that the spike in antibiotic use would lead to more resistant bacterial infections.  The same thing is now happening with COVID-19, but on an arguably much vaster scale.” The COVID-19 pandemic poses a threat to our antibiotic infrastructure, which is already compromised due to a lack of new therapies.  That threat makes antimicrobial stewardship even more important.  Adhering to treatment guidelines for shorter antibiotic duration is a critical part of reducing antibiotic use and resistance.

Opinions Expressed in this article are not necessarily those of bioMérieux, Inc.

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