The day may come when a 14-day antibiotic regimen is regarded as overkill in the fight against your child’s sudden infection.
Maybe five days may do the trick, or even three.
Maybe one or two.
Other research has gone further, suggesting an avoidance of antibiotics whenever possible, resorting to them only if you’re battling more serious bacterial infections such as meningitis, pneumonia and sepsis.
“More and more, they’re tailoring therapy specifically to the patient,” said Eric Stever, a clinical pharmacist at the Spectrum Health Helen DeVos Children’s Hospital pharmacy. “And they’re making sure that the patient needs to be on antibiotics to begin with.”
Rather than fastidiously tracking multiple antibiotic doses over nearly two weeks, a patient could feasibly complete a course in a few days.
And while a shortened regimen isn’t necessarily the most dramatic change, it could make life easier for patients.
One study of antibiotic treatment of acute bacterial sinusitis found a shorter course, lasting fewer than seven days, had “comparable effectiveness” to longer courses that stretched up to 14 days.
That study and others like it are drawing conclusions: Shorter treatment periods would suggest ease of use, better compliance rates, fewer adverse effects and, perhaps most importantly, lower rates of antibiotic resistance.
Even as parents of young children would no doubt embrace easier treatments, abbreviated timeframes aren’t necessarily a leading concern among researchers.
“That would be a bonus—that’s not a primary consideration,” Stever said.
Antibiotic resistance is the real driver behind any change.
“A lot of the clinical decision-making these days, in antibiotics selection, is about minimizing antibiotic resistance,” Stever said. “About making sure the treatment is right for the patient—making sure they’re cured from their ailment.”
Health leaders have been sounding the alarm on the looming crisis for years. Antibiotics usage has surged in the past 50 years.
The Centers for Disease Control and Prevention called special attention to the problem during the annual antibiotic awareness week.
Overuse or misuse of antibiotics, one of the most commonly prescribed drugs in the world, are leading factors in the rise of resistance to the drugs, according to the CDC.
“The use of antibiotics is the single most important factor leading to antibiotic resistance around the world,” CDC officials have said, noting that 50 percent of all antibiotics are either unnecessary or ineffective as prescribed.
In the U.S., an estimated 2 million people become infected with antibiotic-resistant bacteria each year and more than 23,000 die from the resulting infection. These realities have prompted a careful examination of the proper place for antibiotics in modern medicine.
Shortened treatments are only a component of this—albeit a critical one.
A 2014 study by the Obama administration teased out a national strategy for combating antibiotic-resistant bacteria, emphasizing the accelerated research and development of new antibiotics as well as “vaccines, additional therapies and diagnostics.”
The study underscored the value of an “antibiotic stewardship” program, which would “help providers prescribe the right antibiotic for the right amount of time and prevent prescription of antibiotics for non-bacterial infections.
Continued the study: “It is imperative that such programs become a routine and robust component of health care delivery in the United States.”
“It’s an interesting topic,” Stever said.
He cautioned, however, that shorter treatments or alternatives are appropriate only for “uncomplicated cases.” In cases of serious infection, longer treatments may always be the norm.
But the point is, researchers are asking these important questions, he said.
“Is it really necessary to treat with antibiotics, and for as long as previously thought?” Stever said. “That’s where that inquisitive spirit has come from.”
While some doctors will still dole out a 14-day antibiotic for a urinary tract infection, others may simply prescribe a three-day course, Stever said.
“That’s one area where they’ve shortened the duration,” he said.
Other areas are evolving.
Research has shown that ear infections, sinusitis and cellulitis all respond well to shorter treatments, but this doesn’t mean short treatments are typical, he said.
“We haven’t really seen this manifested in practice yet,” Stever said. “A lot of the treatment guidelines have stayed unchanged—but it’s relevant that the questions are being asked.”
The less complex cases appear most ripe for less rigorous therapies. Patients with a family history of MRSA, or a compromised immune system, aren’t likely to see shorter therapies, Stever said.
With many classes of antibiotics, and dozens of broader categories and dozens more drugs beyond that, this realm of medicine has become highly specialized, Stever said.
At Spectrum Health, this is where the antibiotic stewardship program comes into play.
“The (antibiotic stewardship program) team helps guide the physicians with antibiotics selection,” Stever said.
The group helps doctors choose the appropriate “broad-spectrum” antibiotic to start a therapy, fine-tuning the treatment later if ensuing lab cultures reveal the presence of a pathogen that a simpler antibiotic could eradicate, he said.
For patients and parents of little patients, there remains a pertinent bit of advice: Don’t ever be afraid to ask questions about an antibiotic prescription.
“It’s OK to ask,” Stever said. “Pediatricians at Spectrum Health are very thorough and knowledgeable. They do a great job with their dosing—and they are, like we are here, pretty judicious about using antibiotics.”
Stever remains confident that researchers will continue to develop findings that steer clinical guidelines in the best direction.
“It just takes some time for the community to warm up to that (new) idea, and change their guidelines,” he said. “People need to see it in practice. A lot of clinicians are guided by personal experience.”