I was watching a lecture on YouTube, another adaptation to the pandemic. I am a member and past president of the Texas Club of Internists, an almost 100 year old organization dedicated to continuing medical education for Texas internists. https://www.texasclubofinternists.org/. Normally, we meet twice a year for CME courses. One is in state and the other is out of state. For our spring meeting, we watch the lectures on video and then have a virtual meeting to interact with the lecturers. I just finished watching a lecture by Dr. Herbert Dupont, the world’s foremost authority on infectious diarrhea. Sounds thrilling, right? He is an engaging speaker who speaks without notes and has spoken to the club on multiple occasions since 1969! He is also a member of our club..https://www.webmd.com/herbert-l-dupont.
He spoke on Clostridia dificile colitis. Also known as C. dif. It is one of the most lethal infectious diseases and is associated with the overuse of antibiotics which disrupt the normal bacteria in the gastrointestinal tract and lead to an over abundance of the this type of bacteria which causes inflammation of the colon and profuse diarrhea. It brought to mind the latest recommendations from the the American College of Physicians which outline the appropriate duration of antibiotic treatment for common infections.
Advice from ACP supports short courses of antibiotics for several common infections
Because at least 30% of antibiotic use is considered unnecessary, best practices were issued on treatment of chronic obstructive pulmonary disease exacerbation and uncomplicated bronchitis, community-acquired pneumonia, uncomplicated urinary tract infection, and cellulitis.
ACP has issued Best Practice Advice with recommendations for the appropriate use of antibiotics for four common bacterial infections.
“Appropriate Use of Short Course Antibiotics in Common Infections: Best Practice Advice from the American College of Physicians” focuses on prescribing appropriate and short-duration antibiotics for patients presenting with four common infections. It was published April 6 by Annals of Internal Medicine.
The four Best Practice Advice items are as follows.
- Chronic obstructive pulmonary disease (COPD) exacerbation and acute uncomplicated bronchitis. Clinicians should limit antibiotic treatment duration to five days when managing patients with exacerbations of chronic obstructive pulmonary disease 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).
- Community-acquired pneumonia. Clinicians should prescribe antibiotics for a minimum of five days. Any extension of therapy should be guided by validated measures of clinical stability, which include resolution of vital sign abnormalities, ability to eat, and normal mentation.
- Uncomplicated urinary tract infection. In women with uncomplicated bacterial cystitis, clinicians should prescribe short-course antibiotics, specifically nitrofurantoin for five days, trimethoprim-sulfamethoxazole for three days, or fosfomycin as a single dose. In men and women with uncomplicated pyelonephritis, clinicians should prescribe short-course therapy with fluoroquinolones (five to seven days) or trimethoprim-sulfamethoxazole (14 days) based on antibiotic susceptibility.
- Cellulitis. In patients with nonpurulent cellulitis, clinicians should use a five- to six-day course of antibiotics active against streptococci, particularly for those who are able to self-monitor and have 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 paper stated. In the United States, at least 30% of antibiotics are considered unnecessary and treatment is often continued too long, it noted.
I look forward to seeing my colleagues from around the state when we meet in person in the fall.
