Image of Amir Qaseem, M.D., Ph.D., MHA

Several common bacterial infections can be treated effectively with shorter courses of antibiotics than traditionally prescribed, according to new guidance released April 6 by the American College of Physicians.

The guidance focuses in particular on bronchitis, pneumonia, urinary tract infection and skin infections (cellulitis). 

“Doctors and patients should be aware that using antibiotics for shorter periods of time can have the same — and often better — results compared with longer periods and can also help lower antibiotic resistance,” wrote Amir Qaseem, M.D., Ph.D., director of clinical policy at ACP, and colleagues.

The recommendations describe best practices for appropriate short-duration prescribing for the following conditions and in these circumstances:

  • Treatment using antibiotics in patients with uncomplicated pneumonia should be for at least five days. The patient’s clinical symptoms should guide decisions to treat for longer than five days.
  • When treating uncomplicated bladder infection in women, limit treatment to five days of nitrofurantoin, three days of trimethoprim–sulfamethoxazole (TMP–SMX), or one dose of fosfomycin.
  • Treatment of uncomplicated kidney infection should be limited to either five to seven days fluoroquinolone or 14 days of TMP–SMX. Laboratory tests should guide the choice of antibiotic types.
  • Uncomplicated skin infection treatment should be limited to five to six days of an antibiotic that covers streptococci, a common cause of these infections.

Using antibiotics unnecessarily or for longer periods than necessary may expose patients to drug side effects without any benefit and can contribute to antibiotic resistance, the authors said.

The new guidance may not apply to immunocompromised persons, people with complicated infections due to other causes, complicated anatomy, or a recent history of resistant bacterial infections, among other considerations, they advised.

The guidance appears in the Annals of Internal Medicine.