HealthDay News — In a Best Practice Advice document issued by the American College of Physicians and published online in the Annals of Internal Medicine, recommendations are presented for prescribing appropriate and short-duration antibiotic therapy for patients with common bacterial infections.

Rachael A. Lee, MD, MSPH, from the University of Alabama at Birmingham, and colleagues conducted a narrative literature review of published clinical guidelines, systematic reviews, and individual studies that addressed common bacterial infections to describe best practices for appropriate and short-duration antibiotic therapy prescribing.

The researchers recommend limiting antibiotic treatment duration to 5 days when managing patients with chronic obstructive pulmonary disease (COPD) exacerbations and acute uncomplicated bronchitis who have clinical signs of bacterial infection. For community-acquired pneumonia, clinicians should prescribe antibiotics for a minimum of 5 days; extension of therapy should be guided by validated measures of clinical stability, including resolution of vital sign abnormalities, ability to eat, and normal mentation.


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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 women with uncomplicated bacterial cystitis. Short-course therapy with fluoroquinolones or TMP-SMZ based on antibiotic susceptibility is recommended for women and men with uncomplicated pyelonephritis. A 5- to 6-day course of antibiotics active against streptococci is recommended for patients with nonpurulent cellulitis, especially those able to self-monitor, with close follow-up with primary care.

“Clinicians, especially general internists, play a key role in antimicrobial stewardship, and quality improvement strategies can improve antimicrobial prescribing,” the authors wrote.

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