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 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==
 
{| class="wikitable"
  
{| class="wikitable"
 
!Diagnosis
  
!Diagnosis
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|7
  
|7
 
|-
  
|-
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|[[Intra-abdominal infections]]
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|[[Intra-abdominal infection]]
 
|4
  
|4
 
|10
  
|10
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|}
   
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== Further Reading ==
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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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*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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*[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]]

Latest revision as of 10:27, 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

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