Appropriate Use of Short-Course Antibiotics in Common Infections
Best Practice Advice
Best Practice Advice 1:
Clinicians should limit antibiotic treatment duration to 5 days when managing patients with COPD exacerbations and acute uncomplicated bronchitis who have clinical signs of a bacterial infection (presence of increased sputum purulence in addition to increased dyspnea, and/or increased sputum volume).
Best Practice Advice 2:
Clinicians should prescribe antibiotics for community-acquired pneumonia for a minimum of 5 days. Extension of therapy after 5 days of antibiotics should be guided by validated measures of clinical stability, which include resolution of vital sign abnormalities, ability to eat, and normal mentation.
Best Practice Advice 3:
In women with uncomplicated bacterial cystitis, clinicians should prescribe short-course antibiotics with either nitrofurantoin for 5 days, trimethoprim–sulfamethoxazole (TMP–SMZ) for 3 days, or fosfomycin as a single dose. In men and women with uncomplicated pyelonephritis, clinicians should prescribe short-course therapy either with fluoroquinolones (5 to 7 days) or TMP–SMZ (14 days) based on antibiotic susceptibility.
Best Practice Advice 4:
In patients with nonpurulent cellulitis, clinicians should use a 5- to 6-day course of antibiotics active against streptococci, particularly for patients able to self-monitor and who have close follow-up with primary care.
Recommendation Grading
Overview
Title
Appropriate Use of Short-Course Antibiotics in Common Infections
Authoring Organization
American College of Physicians
Publication Month/Year
April 6, 2021
Last Updated Month/Year
April 1, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Ambulatory, Emergency care, Hospital
Intended Users
Physician, nurse, nurse practitioner, physician assistant
Scope
Management
Diseases/Conditions (MeSH)
D017714 - Community-Acquired Infections
Keywords
community-acquired pneumonia, urinary tract infection (UTI), chronic obstructive pulmonary disease (COPD), antimicrobial, Short-Course Antibiotics, Common Infections, acute bronchitis, Cellutitis