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This article comes from the NEJM Journal Watch ACP Recommends Short-Course Antibiotics for Many Common Infections.
The American College of Physicians recommends short-term antibiotic treatment for a variety of common infections.
The author: Robert L.
Barbieri, MD, said the American College of Physicians It is most appropriate to take the medicine for 5 days.
Organizer: American College of Physicians (ACP).
Background Nearly one-third of antibiotic prescriptions prescribed by physicians exceed the necessary duration of medication, and about 20% of patients have antibiotic-related adverse events, including allergies, Clostridium difficile infection and antibiotic resistance.
ACP experts provided the best evidence-based recommendations on the most reasonable use of antibiotics for common bacterial infections in outpatients and inpatients.
Key recommendations (1) Acute exacerbation of chronic obstructive pulmonary disease (without complications) characterized by purulent sputum with increased dyspnea, increased sputum volume, or both.
Common bacterial pathogens: Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis.
Recommended antibacterial agents: amoxicillin clavulanate, azithromycin or doxycycline.
Suggested medication time: 5 days.
(2) Community-acquired pneumonia.
Common bacterial pathogens: Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae (and less common Staphylococcus aureus or Legionella).
Recommended antibacterial agents: amoxicillin, doxycycline or azithromycin (used in other healthy patients); or β-lactams combined with macrolides or fluoroquinolones acting on the respiratory system (used for Patients with comorbidities).
Suggested medication time: 5 days (if the vital signs or mental state are still abnormal, the medication time can be extended after 5 days).
(3) Urinary tract infection.
Uncomplicated female patients with cystitis: nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole (TMP-SMZ) for 3 days or fosfomycin for 1 day.
Uncomplicated male or female patients with pyelonephritis: fluoroquinolones (such as ciprofloxacin) acting on the urinary system should be treated for 5 days or TMP-SMZ for 14 days.
Guide the selection of antibiotics based on pathogen culture and drug susceptibility data.
(4) Non-suppurative cellulitis.
Common bacterial pathogens: Streptococcus or Staphylococcus aureus.
Recommended antibacterial agents: cephalosporins (e.
g.
cephalexin), anti-staphylococcal penicillins (e.
g.
dicloxacillin) or clindamycin (for no penetrating injury and no evidence of methicillin-resistant Staphylococcus aureus infection [For example, patients with a history of MRSA colonization or infection]).
Suggested medication time: 5 days (especially for patients who are capable of self-monitoring and can receive close follow-up in primary care institutions).
Comments In the long run, for patients with common infections without complications, shortening the administration time of antibacterial agents is beneficial to them, and it is possible to reduce the side effects of drugs and the cost of treatment.
The ACP guidelines will lead us into the 2020s to improve the effectiveness of treatment by reducing drugs.
Commented article Lee RA et al.
Appropriate use of short-course antibiotics in common infections: Best practice advice from the American College of Physicians.
Ann Intern Med 2021 Apr 6; [e-pub].
(https://doi.
org /10.
7326/M20-7355) Related reading NEJM Journal Watch The NEJM Journal Watch is published by NEJM Group.
Internationally renowned doctors are invited to comment on important papers in the medical field to help doctors understand and use the latest developments.
"NEJM Frontiers of Medicine" is translated several times a week, published on the app and official website, and selected 2-3 articles are published on WeChat.
Copyright information This article was translated, written or commissioned by the "NEJM Frontiers of Medicine" jointly created by the Jiahui Medical Research and Education Group (J-Med) and the "New England Journal of Medicine" (NEJM).
The Chinese translation of the full text and the included diagrams are exclusively authorized by the NEJM Group.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal liabilities.
The American College of Physicians recommends short-term antibiotic treatment for a variety of common infections.
The author: Robert L.
Barbieri, MD, said the American College of Physicians It is most appropriate to take the medicine for 5 days.
Organizer: American College of Physicians (ACP).
Background Nearly one-third of antibiotic prescriptions prescribed by physicians exceed the necessary duration of medication, and about 20% of patients have antibiotic-related adverse events, including allergies, Clostridium difficile infection and antibiotic resistance.
ACP experts provided the best evidence-based recommendations on the most reasonable use of antibiotics for common bacterial infections in outpatients and inpatients.
Key recommendations (1) Acute exacerbation of chronic obstructive pulmonary disease (without complications) characterized by purulent sputum with increased dyspnea, increased sputum volume, or both.
Common bacterial pathogens: Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis.
Recommended antibacterial agents: amoxicillin clavulanate, azithromycin or doxycycline.
Suggested medication time: 5 days.
(2) Community-acquired pneumonia.
Common bacterial pathogens: Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae (and less common Staphylococcus aureus or Legionella).
Recommended antibacterial agents: amoxicillin, doxycycline or azithromycin (used in other healthy patients); or β-lactams combined with macrolides or fluoroquinolones acting on the respiratory system (used for Patients with comorbidities).
Suggested medication time: 5 days (if the vital signs or mental state are still abnormal, the medication time can be extended after 5 days).
(3) Urinary tract infection.
Uncomplicated female patients with cystitis: nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole (TMP-SMZ) for 3 days or fosfomycin for 1 day.
Uncomplicated male or female patients with pyelonephritis: fluoroquinolones (such as ciprofloxacin) acting on the urinary system should be treated for 5 days or TMP-SMZ for 14 days.
Guide the selection of antibiotics based on pathogen culture and drug susceptibility data.
(4) Non-suppurative cellulitis.
Common bacterial pathogens: Streptococcus or Staphylococcus aureus.
Recommended antibacterial agents: cephalosporins (e.
g.
cephalexin), anti-staphylococcal penicillins (e.
g.
dicloxacillin) or clindamycin (for no penetrating injury and no evidence of methicillin-resistant Staphylococcus aureus infection [For example, patients with a history of MRSA colonization or infection]).
Suggested medication time: 5 days (especially for patients who are capable of self-monitoring and can receive close follow-up in primary care institutions).
Comments In the long run, for patients with common infections without complications, shortening the administration time of antibacterial agents is beneficial to them, and it is possible to reduce the side effects of drugs and the cost of treatment.
The ACP guidelines will lead us into the 2020s to improve the effectiveness of treatment by reducing drugs.
Commented article Lee RA et al.
Appropriate use of short-course antibiotics in common infections: Best practice advice from the American College of Physicians.
Ann Intern Med 2021 Apr 6; [e-pub].
(https://doi.
org /10.
7326/M20-7355) Related reading NEJM Journal Watch The NEJM Journal Watch is published by NEJM Group.
Internationally renowned doctors are invited to comment on important papers in the medical field to help doctors understand and use the latest developments.
"NEJM Frontiers of Medicine" is translated several times a week, published on the app and official website, and selected 2-3 articles are published on WeChat.
Copyright information This article was translated, written or commissioned by the "NEJM Frontiers of Medicine" jointly created by the Jiahui Medical Research and Education Group (J-Med) and the "New England Journal of Medicine" (NEJM).
The Chinese translation of the full text and the included diagrams are exclusively authorized by the NEJM Group.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal liabilities.
