The length of antibiotic courses of therapy has rarely been rigorously studied, despite its apparent importance as a driver of microbial resistance in humans. Studies that were performed in the past have mainly concentrated on outpatient infections such as tuberculosis, malaria, and venereal diseases, with the main aim to keep compliance as high as possible and cost as low as possible. On the other hand, these issues in hospitalized patients were less relevant. The relevance and importance of bacterial resistance only started to be realized and seriously appreciated some 20 years ago, stressing the importance of the effect of antibiotic therapy on the develop-ment and spread of resistant microorganisms within hospitalized patients and individuals in the community. The introduction of new bactericidal agents with a rapid onset of action (particularly the carbapenems and fluoroquinolones), a deeper understanding of pharmacodynamics of antibacterial agents, and a better definition of patient populations have also contributed to the rationalization of antibiotic dosing and the ability to shorten antibiotic therapy courses. In this respect, one example is single-dose therapy for gonorrhea with ceftriaxone, cefixime, ciprofloxacin, ofloxacin, azithromycin, or doxycycline; therapy that previously lasted about 1 week. Very long courses of tuberculosis treatment have been reduced from around 18 to 24 months to much shorter periods-4 to 6 months in immunocompetent hosts (1)-as a result of the introduction of rifampin (a highly bactericidal agent) and directly observed therapy (DOT), which assures better compliance and therefore a lower rate of resistance development. The ability to treat meningococcal meningitis in children with 4 days of ceftriaxone therapy, or even a single administration of long-acting penicillin (2), or in adults with 2 days of ceftriaxone or 4 days of penicillin G also demonstrate the change occurring in our understanding of the necessary therapeutic period. In hospitals, the reduction of presurgical prophylaxis to a single dose (3) with no untoward effect on wound infection but with a significant reduction in resistant gram-negative wound isolates demonstrates the utility of short and ultra-short therapy and prophylaxis.
|Title of host publication
|Subtitle of host publication
|Concepts and Strategies in Clinical Practice
|Number of pages
|Published - 1 Jan 2004