Updated advice on duration of treatment for common infections
Prevention of development and spreading of antimicrobial resistance remains a global health priority. It should be achieved by improving awareness of the problem, strengthening knowledge through surveillance and assessment, reducing the incidence of infections, and optimising the use of antimicrobial agents (1). Numerous resources, toolkits and pieces of guidance have been developed by the National Institute for Health and Care Excellence (NICE), Public Health England (PHE), Royal Colleges and other bodies to support governments, health organisations and prescribers in tackling the problem of antimicrobial resistance (2).
The latest Medicines Evidence Commentary published by NICE in June this year concentrates on the duration of antimicrobial treatment for the most common infections treated in thecommunity. Despite published guidance, a recent study that looked at prescribing data from over 900,000 consultations in England between 2013 and 2015 found that the majority of cases resulted in overprescribing of treatment. More than 80% of prescriptions for the most common infections like acute cough and bronchitis, acute sore throat, acute otitis media and acute exacerbations of COPD were issued for a longer duration than recommended (3).
In the past, it was thought that longer antibiotic treatment would prevent development of resistance as the main concern was with the microorganism causing the infection. The more recent approach shifts focus to the resistance developing in the common commensal bacteria as longer exposure may lead to selection of resistant strains with greater risk of resistance in future infections. Excess use of antibiotics is also associated with increased risk of side effects such as diarrhoea, rash, thrush and C. Difficile infections, as well as increased cost and waste (2).
NICE and PHE have jointly published antimicrobial prescribing guidelines for a range of common infection topics, which include recommendations on the choice, dosage and course length of antibiotics. The guidance reminds prescribers to use the shortest effective course (4).
The current recommendations for duration of antimicrobial treatment (where appropriate) for the most common indications is summarised in Figure 1 (see below).
NICE has also published guidance on antimicrobial stewardship which aims to change prescribing practice and advise practitioners, carers and the general public to protect current antibiotics and ensure their effectivity for the future (5).