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CME

ACP Guidelines: Best Practices for Use of Short-Duration Antibiotics for Common Infections

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Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Discuss the ACP guidance on reducing duration of antibiotic treatment for common infections
2. Describe the reasoning behind limiting the duration of antibiotic use in the context of resistance

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.


The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from 12/01/2022 through 12/01/2024, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the test and evaluation. Upon registering and successfully completing the test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Read Disclaimer & Fine Print

SUMMARY:

The American College of Physicians (ACP) addresses the use of antibiotics for common infections (COPD, community-acquired pneumonia, UTIs, and cellulitis). Evidence-based, the overall purpose of this document is to “describe appropriate use of shorter durations of antibiotic therapy for common bacterial infections seen in both inpatient and outpatient health care settings.”

KEY POINTS:

  • Antibiotics/antimicrobials are prescribed in 10% of all outpatient PCP visits
    • 30% of these prescriptions are unnecessary and continue for longer than needed
    • Overuse causes antibiotic resistance and “adverse events” in 20% of patients | Considered a national threat by ACP and the CDC
  • Definition of appropriate antibiotic use: “Right antibiotic at the right dose for the right duration”
  • Current guidelines support shortening the duration of antibiotic use
    • However, to prevent antibiotic resistance, many physicians prescribe longer courses of treatment, irrespective of the condition (around 10 days)
  • Resistance
    • Evidence shows that there is no correlation between shorter course of antibiotics and increased resistance
    • Due to “natural selection,” resistance is more likely to occur with longer course therapy

COPD Exacerbation and Acute Uncomplicated Bronchitis

Bronchitis

  • Antibiotics are not recommended unless there is suspicion of pneumonia

COPD

  • Antibiotics are recommended due to high risk of underlying bacterial infection
  • Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends
  • Treating COPD with antibiotics if an underlying bacterial infection is suspected needs 2 out of 3 criteria
    • Increased shortness of breath
    • Increased sputum volume
    • Purulence
  • Limit to 5 days of therapy

Community-Acquired Pneumonia

  • Antibiotics are recommended for a minimum of 5 days (American Thoracic Society/IDSA guideline)
    • However, when determining length of treatment, consider validated measures of clinical stability (e.g., resolution of vital sign abnormalities, ability to eat, and normal mentation)
  • Evidence suggests that every additional day of treatment is associated with a 5% increased risk for an “adverse event”

Uncomplicated Cystitis and Pyelonephritis

  • UTIs
    • Most common bacterial infection that presents for medical attention
    • Infectious cystitis primarily caused by Escherichia coli (75% of bacterial cases)
  • Therapy durations based on antibiotic type
    • Nitrofurantoin: 5 days
    • TMP–SMX: 3 days
    • Fosfomycin: Single dose
  • Fluoroquinolones
    • 3-day administration
    • Due to adverse events, reserve use for patients with history of resistant organisms
  • Pyelonephritis
    • IDSA/ESCMID (European Society of Clinical Microbiology and Infectious Diseases) guideline only addresses female patient
    • ACP Recommendation (not hospitalized, males and females): Oral fluoroquinolone for 7 days or TMP–SMX for 14 days | TMP–SMX should not be used as the only therapy without “culture and susceptibility testing in pyelonephritis”
    • Some clinical trials have showed that fluroquinolones can effectively be reduced to 5 days (cure rate of 93%; noninferior studies comparing 5-day course to 10-day course)
    • Recommendations for a shorter course of TMP–SMX are not yet determined | More clinical trials are needed

Note: UTIs in pregnant women, complicated UTIs (related to “structural or functional abnormalities” in the urinary tract), and acute bacterial prostatitis are not covered in this best practice statement

Cellulitis

  • Nonpurulent cellulitis
    • Usually caused by streptococci
  • Add methicillin-resistant Staphylococcus aureus coverage for the following
    • Purulent cellulitis
    • Cellulitis associated with
      • Penetrating trauma | Evidence of MRSA infection elsewhere | Nasal colonization with MRSA | IV drug use | Systemic inflammatory response syndrome
  • IDSA guideline (2014)
    • Recommends that “patients should receive antibiotics for uncomplicated cellulitis but that clinicians should consider extending treatment if the infection has not improved after 5 days”
  • NICE (2019)
    • Recommends treatment for 5 to 7 days
  • More studies are needed to further clarify the best duration of antibiotic treatment for soft tissue infections (SSTIs)

Note: Purulent SSTIs such as furuncles, carbuncles, and abscesses, usually require incision and drainage and are not addressed in this document

Learn More – Primary Sources:

Annals of Internal Medicine: Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians

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Related ObG Topics:

Diagnosis and Management of Stable COPD
Guideline for the Treatment of Community-Acquired Pneumonia: Outpatient Diagnosis and Management
Uncomplicated Cystitis: When to Culture, How to Treat and Recommended Prevention Strategies

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Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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