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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+ | |- |
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+ | ! colspan="3" |Urinary Tract Infections |
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+ | |- |
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+ | |Women or adolexcents 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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− | == |
+ | ==Further Reading== |
− | * |
+ | *Brad Spellber's [https://www.bradspellberg.com/shorter-is-better Shorter is Better] website |
− | * |
+ | *[https://www.ammi.ca/Content/Duration%20of%20Therapy%20nov%2024.pdf AMMI Practice Point: Duration of Antibiotic Therapy for Common Infections] |
[[Category:Infectious diseases]] |
[[Category:Infectious diseases]] |
Revision as of 16:31, 3 January 2021
AMMI
Infection | Duration | Comments |
---|---|---|
Urinary Tract Infections | ||
Women or adolexcents 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
- Brad Spellber's Shorter is Better website
- AMMI Practice Point: Duration of Antibiotic Therapy for Common Infections