ACP Guidelines: Best Practices for Use of Short-Duration Antibiotics for Common Infections
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
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
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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.
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.”
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
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)
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
Antibiotics are not recommended unless there is suspicion of pneumonia
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 (such as increased sputum volume or purulence)
5 to 7 days of therapy
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
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
Due to adverse events, reserve use for patients with history of resistant organisms
IDSA/ESCMID (European Society of Clinical Microbiology and Infectious Diseases) guideline only addresses female patient
Recommendation (not hospitalized): 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
Nonpurulent cellulitis usually caused by methicillin-resistant Staphylococcus aureus (MRSA) and streptococci
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”
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
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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.
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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