New Rule: When it comes to the length of time you should take an antibiotic, “Shorter is Better”

Brad Spellberg, MD. Chief Medical Officer and Professor of Clinical Medicine at the Los Angeles County-University of Southern California Medical Center.

Brad Spellberg, MD. Chief Medical Officer and Professor of Clinical Medicine at the Los Angeles County-University of Southern California Medical Center.

Neither antibiotics nor the bacteria they aim to kill are what we thought they we were. To the contrary, it turns out that antibiotics have a huge downside and bacteria have a huge upside. As a consequence, our relationship to both has changed. With respect to antibiotics we want to flip the script from Hey doc, I want an antibiotic, to Hey doc, do I really need an antibiotic? And if they answer is Yes, you do need an antibiotic, then you want to take it for as short a time as possible.

Those are the words of Brad Spellberg, MD, a leading world authority on bacterial-driven infectious disease. Writing in Medscape News this month, Spellberg says it’s a myth that “patients must complete every dose of antibiotics prescribed, even after they feel better.” He explains:

Every randomized clinical trial that has ever compared short-course therapy with longer-course therapy … has found that shorter-course therapies are just as effective … This myth needs to be replaced by a new antibiotic mantra: ‘Shorter is better!’ Patients should be told that if they feel substantially better, with resolution of symptoms of infection, they should call the clinician to determine whether antibiotics can be stopped early. Clinicians should be receptive to this concept, and not fear customizing the duration of therapy.

Spellberg gave further details last month in his editorial in JAMA Internal Medicine. Comparing a shorter 5 day course of antibiotics versus the standard 10 day regimen, researchers found that the “30-day rates of clinical success were significantly higher for short-course versus standard therapy,” and that “the readmission rate was significantly lower,” for the short-course therapy.

Spellberg also points out the broader societal reason for limiting antibiotic use: “We’re having a public health crisis of antibiotic resistance not just in the US but internationally: as resistance rates keep rising, as new antibiotic development declines, we’re running into patients we can’t treat, who have infections we can’t treat for the first time since 1934, and that is a very frightening thing for the medical community to confront.”

The overall equation is this: The more you use antibiotics — in people and in animals —- the more the bugs get used to them and become immune. That’s just natural selection at work. Therefore, cautions Spellberg, “Don’t take antibiotics unless you really need them.” And if you do need them, “The shorter the better.”

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