Shorter is better

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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 infections 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