Introduction
The discovery and widespread introduction of antibiotics into medical practice was seen as a revolution in medicine. Since then, these drugs have become faithful assistants to doctors in the struggle for patients’ lives. The substances of this medical group serve as a powerful weapon in the fight against dangerous diseases. Nevertheless, today, there is a certain tendency that consists in the rejection of long-term courses of an antibiotic treatment since some significant side effects can be manifested.
The human body can adapt to almost any state, and it is logical to assume that if the course of treatment with special antibiotic drugs is protracted, harmful microorganisms will eventually be able to resist even potent preparations. It, in turn, will lead to additional complications since new ways of treatment will have to be looked for and tested. Therefore, one of the central allegations is that the duration of antibiotic treatment should be reduced provided that there are positive dynamics; otherwise, the state of health will be irresistibly worsened.
Benefits of Shortened Antibiotic Courses
Antibiotic resistance is noted to depend on individual cases and patients’ health characteristics. Appropriate selection of antibiotics can influence the infection resistance as well. Therefore, the optimal use of antibiotics should be researched for specific diseases to develop the appropriate guidance strategies. It is generally recognized that currently the failures to complete the antibiotic course is regarded as an irresponsible behavior of a patient. Still, in some cases, the reduction of treatment course does not have any negative effects on patient outcomes (Schuler et al., 2016). Moreover, overtreatment may cause higher rates of infection recurrence and resistance to antibiotics.
Usually, the courses of antibiotics are prescribed by precedent and are led by fear of insufficient treatment. In many cases, the research to detect minimum treatment duration that can be effective was not conducted as well. Thus, long courses of antibiotics are prescribed mainly because of a false sense of security as the data on the effect of shorter courses is absent (Uranga et al., 2016). It is emphasized that short courses might reduce the efficiency of treatment in some cases, but differences usually are limited to the prolongation of disease symptoms and not to the failure of treatment.
The shortened courses of antibiotic treatment have many advantages. They are widely associated with a small rate of antimicrobial resistance of respiratory pathogens. Some researchers note that “low doses of β-lactam antibiotics for more than 5 days have been associated with an increase in Streptococcus pneumonia penicillin-resistant nasopharyngeal carriers” (Uranga et al., 2016, p. 1258). Moreover, reducing the length of antibiotic treatment might limit the occurrence of adverse effects and result in cost savings.
Despite the benefits of shortened antibiotic courses, such an approach to treatment is rather challenging as many physicians are led by a false belief of security in prescribing long courses of antibiotics. At present, it is advised to prescribe a minimum of five days of antibiotic treatment, while the longer periods are recommended if the results of the initial therapy were negative (Uranga et al., 2016). Nevertheless, most recommendations have weak evidence and are based on the opinion of the experts.
Equal Efficiency of Long and Short Antibiotic Courses
In many cases, the duration of treatment with antibiotics can be reduced without decreasing its efficiency. It is a general opinion that for treating acute pharyngitis, ten days of amoxicillin course is beneficial (Pereira, Ramos, Mação, Januário, & Januário, 2017). Still, the length of antibiotic treatment can be reduced from ten to seven days after the appropriate evaluation of treatment outcomes. This infection is very common among children and deals with the upper respiratory tract. The bacterial agent that might cause it is called group A streptococcus.
Usually, additional tests are conducted to avoid inadequate prescription of antibiotic treatment. If group A streptococcus pharyngitis is confirmed, such first-line antibiotics as amoxicillin and penicillin are prescribed. However, sometimes the failures of treatment are reported due to the presence of bacteria that produce β-lactamase in the oral environment. Therefore, a long course of antibiotics is necessary to obtain the most effective infection eradication.
Symptomatic improvement is expected in one or two days of treatment in such cases. The reduction of treatment duration from ten to seven days is proved to be equally effective both at the bacteriological and clinical levels. For this study, the patients were divided into two groups, one of which received short-term antibiotic treatment. It is stated that “the number of patients that returned to the PED in the next 30 days by another episode of GAS pharyngitis was 22, being 2.7% of group A and 2.8% of group B” (Pereira et al., 2017, p. 3). Thus, the shorter antibiotic course did not cause any negative effects and could be applied in the future practice of pharyngitis treatment.
Impact of Individual Factors on Antibiotic Treatment Efficiency
The concept of a set antibiotic course does not take into account the fact that various patients might respond differently to the same medicine due to diverse individual factors. Therefore, various quality improvement methods can be applied to improve the practice of antibiotic treatment and health outcomes, especially among children who are vulnerable to diverse effects. For instance, short courses of antibiotics might be beneficial for treating skin and soft tissue infections among children to reduce costs and prevent the occurrence of resistant bacteria, as well as decrease unintended effects (Schuler et al., 2016). At present, it is recommended to utilize a five-day course of antibiotic treatment and prolong it in case of the absence of notable improvement.
Various health care providers practice variations in treatment regimens and length of therapy to manage this disease. Some researchers state that treatment plans should include such factors as patient age, infection location, severity, and underlying immunodeficiency (Schuler et al., 2016).
These factors might significantly impact the duration of therapy and the choice of antibiotics. It might assist in reducing unnecessary long antibiotic treatment received by children. The improvement of interventions and access to best practices would be beneficial for educating the physicians to select the optimal length of antibiotic treatment according to patient needs. Such practice is proved to shorten the antibiotic courses for children suffering from skin and soft tissue infections.
Treatment Duration and Adverse Effects
It is advisable to select an appropriate length of antibiotic treatment to avoid adverse effects and reduce health care costs. For example, there have been reported thousands of hospitalizations because of sepsis, which is an inflammatory response to serious infection and requires antibiotic treatment (Iskander, Vaickus, Duffy, & Remick, 2016). Sepsis has a great risk of death, which causes the administration of antibiotics of broad-spectrum at early stages to increase the effectiveness of the treatment. Nevertheless, the length of antimicrobial therapy for treating sepsis greatly influences the treatment costs, secondary infections, and occurrence of resistant microorganisms.
Although antibiotics are necessary for the management of life-threatening conditions, prolonged duration of their administration might cause the development of multi-drug resistant microorganisms. Some researchers note that “biomarkers such as procalcitonin (PCT) have been proposed to help guide the difficult clinical decision
of when to stop antibiotics” (Iskander, Vaickus, Duffy, & Remick, 2016, p. e0163005). To avoid infections with such resistant organisms as Candida species or Clostridium difficile and reduce costs it is beneficial to shorten the duration of antibiotic treatment for the patients who suffer from sepsis.
Utilizing of procalcitonin is reported to reduce the average antibiotic therapy duration by two days without any negative effects on health outcomes. Another biomarker that can be applied to shorten the duration of antibiotic use is C-reactive protein (Iskander, Vaickus, Duffy, & Remick, 2016). For a simpler identification of necessity to determine the termination of antibiotic administration, such symptoms as fever and leukocytosis presence are used. Still, utilizing biomarkers might be a more effective approach to evaluating the length of antibiotic treatment for patients who suffer from sepsis.
Indicating the duration of antibiotic treatment based on clinical response seems to have more positive outcomes than utilizing the recommended treatment length. This method has been proved to be effective for treating community-acquired pneumonia which causes many cases of mortality worldwide (Uranga et al., 2016). It is noted that if the patient reaches a stable condition, the administration of antibiotics can be stopped within the next two days.
It should be noted that the oral consumption of antibiotics after stopping intravenous administration can be continued without significant differences in outcomes and time of returning to normal activity. Quinolones are reported to have killing properties when their concentration is high. It is noted that “high-dose regimens would tend to increase the area under the concentration-time curve and peak plasma concentration, making shortened antibiotic treatments safe in terms of efficacy” (Uranga et al., 2016, p. 1263). The conducted studies proved that lower doses of quinolones have the same beneficial effect on clinical outcomes. Therefore, shortening the length of antibiotics administration results in improved adherence, lower costs, and decreasing adverse effects.
Conclusion
Although many physicians traditionally keep recommending to complete the prescribed course of antibiotics, the duration of antibiotic treatment can be shortened in some cases if a patient feels better because it will reduce the unnecessary use of antibiotics and improve health outcomes. Shortening of antibiotic courses is beneficial for the patients as it assists in reducing medical costs and decreasing diverse effects that might lead to negative outcomes.
It is noted that the length of antibiotic treatment impacts the resistance to medications and the development of resistant microorganisms. In many cases, the duration of antibiotic treatment can be reduced without any negative effects on clinical outcomes. These findings are beneficial for improving the treatment of skin and soft tissue disease and acute pharyngitis in children as short-term antibiotic administration might help to avoid adverse effects.
The optimal length of antibiotic treatment depending on the individual factors might have a positive effect because patients respond to the medications differently. Therefore, the selection of antibiotics and the duration of treatment should be dependent on the evaluation of the patient’s condition and specific factors rather than be applied equally for all the patients based on recommendations on the given disease.
References
Iskander, K. N., Vaickus, M., Duffy, E. R., & Remick, D. G. (2016). Shorter duration of post-operative antibiotics for cecal ligation and puncture does not increase inflammation or mortality. PlOS One, 11(9), e0163005.
Pereira, C. O., Ramos, D., Mação, P., Januário, G., & Januário, L. (2017). Diagnosis and treatment of acute pharyngitis: Is there any benefit on ten-day course of antibiotics? Anales de Pediatría (English Edition), 6(10), 1-5.
Schuler, C. L., Courter, J. D., Conneely, S. E., Frost, M. A., Sherenian, M. G., Shah, S. S., & Gosdin, C. H. (2016). Decreasing duration of antibiotic prescribing for uncomplicated skin and soft tissue infections. Pediatrics, 137(2), e20151223.
Uranga, A., España, P. P., Bilbao, A., Quintana, J. M., Arriaga, I., Intxausti, M., & Capelastegui, A. (2016). Duration of antibiotic treatment in community-acquired pneumonia: A multicenter randomized clinical trial. Journal of American Medical Association Internal Medicine, 176(9), 1257-1265.