Shorter is better: Difference between revisions
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==AMMI== |
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{| class="wikitable" |
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!Infection |
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!Duration |
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!Comments |
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! colspan="3" |Urinary Tract Infections |
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|- |
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|Women or adolescents with uncomplicated [[cystitis]] |
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|[[Nitrofurantoin]] for 5 days, [[TMP-SMX]] for 3 days, [[fosfomycin]] for 1 day |
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|young non-pregnant female adolescents or adults with normal urinary tracts and normal renal function |
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|- |
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|Children with febrile [[urinary tract infection]] |
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|7 to 14 days |
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|assumes upper tract involvement if febrile |
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|- |
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|Adults with [[pyelonephritis]] and [[urosepsis]] |
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|consider initial dose of IV; [[quinolones]] or [[beta-lactams]] for 7 days |
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|excludes patients with urogenital abnormalities, stents, or drains; duration depends on clinical response |
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|- |
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! colspan="3" |Respiratory Tract Infections |
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|- |
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|[[Streptococcal pharyngitis]] |
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|10 days ([[penicillin V]] or [[amoxicillin]]) |
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|studies limited to pediatrics |
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|- |
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|[[Acute otitis media]] |
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|10 days (6 months to 2 years) or 5 days (over 2 years) |
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|if moderately to severely ill with bulging tympanic membrane |
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|- |
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|Acute uncomplicated [[sinusitis]] |
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|5 to 7 days |
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|reassess at 7 days |
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|- |
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|[[Community-acquired pneumonia]] |
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|5 to 7 days |
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|excludes patients with underlying lung disease, immunosuppression, and empyema; depends on clinical response |
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|- |
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|[[Hospital-acquired pneumonia]] |
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|≤7 days |
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|excludes severely immunosuppressed patient or those with collections/abscesses |
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|- |
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|[[Acute exacerbation of COPD]] |
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|5 to 7 days |
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|only if antibiotics are indicated |
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|- |
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! colspan="3" |Intra-abdominal Infections |
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|- |
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|Uncomplicated [[appendicitis]] |
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|pre-operative antibiotics only |
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|if gangrenous or perforated, continue for additional 24 to 48 hours after source control |
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|- |
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|Traumatic bowel perforation |
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|up to 24 hours post-operatively |
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|if operated on within 12 hours of trauma |
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|- |
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|Gastroduodenal perforation |
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|up to 24 hours post-operatively |
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|if operated on within 24 hours |
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|- |
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|Intra-abdominal abscess |
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|<7 days |
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|if source control is adequate, regardless of whether drainage is still in place |
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|- |
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! colspan="3" |Skin Infections |
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|- |
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|Uncomplicated [[cellulitis]] |
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|5 to 7 days |
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| |
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|- |
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! colspan="3" |Bone and Joint Infections |
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|- |
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|Children with acute osteomyelitis |
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|3 to 4 weeks |
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|transition to oral therapy once clinically improving and CRP decreasing |
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|- |
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|Adults with acute vertebral osteomyelitis |
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|6 weeks |
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|excludes those with implantable devices; may be longer for [[Salmonella]] or [[Brucella]] |
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|- |
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|Adults with acute [[septic arthritis]] |
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|2 weeks (small joints) or 4 weeks (large joints) |
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|duration after surgical drainage |
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|- |
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! colspan="3" |Bacteremia |
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|- |
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|[[Enterobacterales]] |
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|7 days |
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|if source control and not associated with syndrome requiring longer therapy |
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|- |
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|[[Staphylococcus aureus]] (uncomplicated) |
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|14 days (IV) |
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|if other focusses are excluded |
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|- |
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|[[Staphylococcus aureus]] (complicated) |
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|4 to 6 weeks (IV) |
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| |
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|- |
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|[[Streptococcus pneumoniae]], with pneumonia |
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|5 to 7 days |
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|if clinically improving |
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|} |
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==Brad Spellberg== |
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{| class="wikitable" |
{| class="wikitable" |
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!Diagnosis |
!Diagnosis |
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|[[Intra-abdominal |
|[[Intra-abdominal infection]] |
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==Further Reading== |
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*Brad Spellber's [https://www.bradspellberg.com/shorter-is-better Shorter is Better] website |
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*[https://www.ammi.ca/Content/Duration%20of%20Therapy%20nov%2024.pdf AMMI Practice Point: Duration of Antibiotic Therapy for Common Infections] |
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[[Category:Infectious diseases]] |
[[Category:Infectious diseases]] |
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Latest revision as of 14:27, 10 March 2022
AMMI
| Infection | Duration | Comments |
|---|---|---|
| Urinary Tract Infections | ||
| Women or adolescents with uncomplicated cystitis | Nitrofurantoin for 5 days, TMP-SMX for 3 days, fosfomycin for 1 day | young non-pregnant female adolescents or adults with normal urinary tracts and normal renal function |
| Children with febrile urinary tract infection | 7 to 14 days | assumes upper tract involvement if febrile |
| Adults with pyelonephritis and urosepsis | consider initial dose of IV; quinolones or beta-lactams for 7 days | excludes patients with urogenital abnormalities, stents, or drains; duration depends on clinical response |
| Respiratory Tract Infections | ||
| Streptococcal pharyngitis | 10 days (penicillin V or amoxicillin) | studies limited to pediatrics |
| Acute otitis media | 10 days (6 months to 2 years) or 5 days (over 2 years) | if moderately to severely ill with bulging tympanic membrane |
| Acute uncomplicated sinusitis | 5 to 7 days | reassess at 7 days |
| Community-acquired pneumonia | 5 to 7 days | excludes patients with underlying lung disease, immunosuppression, and empyema; depends on clinical response |
| Hospital-acquired pneumonia | ≤7 days | excludes severely immunosuppressed patient or those with collections/abscesses |
| Acute exacerbation of COPD | 5 to 7 days | only if antibiotics are indicated |
| Intra-abdominal Infections | ||
| Uncomplicated appendicitis | pre-operative antibiotics only | if gangrenous or perforated, continue for additional 24 to 48 hours after source control |
| Traumatic bowel perforation | up to 24 hours post-operatively | if operated on within 12 hours of trauma |
| Gastroduodenal perforation | up to 24 hours post-operatively | if operated on within 24 hours |
| Intra-abdominal abscess | <7 days | if source control is adequate, regardless of whether drainage is still in place |
| Skin Infections | ||
| Uncomplicated cellulitis | 5 to 7 days | |
| Bone and Joint Infections | ||
| Children with acute osteomyelitis | 3 to 4 weeks | transition to oral therapy once clinically improving and CRP decreasing |
| Adults with acute vertebral osteomyelitis | 6 weeks | excludes those with implantable devices; may be longer for Salmonella or Brucella |
| Adults with acute septic arthritis | 2 weeks (small joints) or 4 weeks (large joints) | duration after surgical drainage |
| Bacteremia | ||
| Enterobacterales | 7 days | if source control and not associated with syndrome requiring longer therapy |
| Staphylococcus aureus (uncomplicated) | 14 days (IV) | if other focusses are excluded |
| Staphylococcus aureus (complicated) | 4 to 6 weeks (IV) | |
| Streptococcus pneumoniae, with pneumonia | 5 to 7 days | if clinically improving |
Brad Spellberg
| Diagnosis | Short (d) | Long (d) | Result | # RCTs |
|---|---|---|---|---|
| Community-acquired pneumonia | 3-5 | 5-14 | = | 10 |
| Ventilator-associated pneumonia | 8 | 15 | = | 2 |
| Pyelonephritis | 5-7 | 10-14 | = | 7 |
| Intra-abdominal infection | 4 | 10 | = | 2 |
| Gram-negative bacteremia | 7 | 14 | = | 2 |
| Cellulitis | 5-6 | 10 | = | 4 |
| Chronic osteomyelitis | 42 | 84 | = | 2 |
| Diabetic foot osteomyelitis, after debridement | 21 | 42 | = | 1 |
| Septic arthritis | 14 | 28 | = | 1 |
| Removed orthopedic implant | 28 | 42 | = | 1 |
| Acute exacerbation of COPD or sinusitis | ≤5 | ≥7 | = | >25 |
| Febrile neutropenia | Afebrile x72 h | + ANC >500 | = | 1 |
| Latent tuberculosis infection | 1-4 mo | 6-12 mo | = | 8 |
| Plasmodium vivax malaria | 7 | 14 | = | 1 |
Further Reading
- Brad Spellber's Shorter is Better website
- AMMI Practice Point: Duration of Antibiotic Therapy for Common Infections
