Busting Antibiotic Therapy Myths
Bacterial resistance to antibiotics is a major obstacle for the treatment of infectious diseases, which may result not only in failed therapy, but also in the growth of healthcare costs. In the United States resistance to antibiotics turns out in additional annual costs in the amount of more than $100 million. Additionally, infections caused by resistant bacteria, usually lead to a prolonged course of the disease, more frequent and prolonged hospitalization and higher mortality. Apart from making use of proven practices, an effective therapy must take into account the possible misunderstanding and myths to ensure decent treatment.
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Myth 1: Antibiotic therapy treatment should last no less than 10-14 days
The modern arsenal of antimicrobial preparations includes drugs used in short courses and even once, e.g.: a 3-5 day course of azithromycin in community-acquired respiratory tract infections, namely in acute streptococcal tonsillopharyngitis, acute otitis media, acute bacterial rhinosinusitis, community-acquired pneumonia, a single administration of fosfomycin trometamol or use fluoroquinolones for witing days in the treatment of acute uncomplicated cystitis, a single use of azithromycin for the treatment of uncomplicated chlamydial infection, azithromycin or ceftriaxone for uncomplicated gonorrhea, short (1-3 days) courses of ceftriaxone for acute otitis media, and so on.
At the same time, there are diseases and conditions in which the duration of the antimicrobial preparations is much higher than the standard 10-14 days and may equal several weeks or even months, for example, tuberculosis, chronic osteomyelitis, chronic prostatitis, purulent pericarditis, bacterial endocarditis, and others.
The fact should be also underlined that the prolonging the course of antibiotic therapy until complete relief of symptoms and normalization of the erythrocyte sedimentation rate (ESR), X-ray pictures, wound healing, and so on is not absolutely required. For example, in acute uncomplicated cystitis, dysuria and leucocyturia present on a 3rd day of treatment with norfloxacin in 78 52.5% of patients, respectively. However, this is not an indication for a longer course of AMP, as the main criterion for the effectiveness of treatment is the bacteriuria ceased by this time in about 94% of the patients.
In general, ESR is a nonspecific indicator that doesn?t allow indicating the presence and extent and dynamics of the infection process. In community-acquired pneumonia, low-grade fever (37 - 37,5°C) in the absence of other signs of bacterial infection may be a manifestation of non-infectious inflammation or postinfectious asthenia (autonomic dysfunction) and is not an indication for the continuation of ABT or replacement of the ILA. Residual changes on radiographs may persist for 1-2 months, rales during auscultation - within 3-4 weeks, dry cough, especially in smokers, patients with chronic obstructive pulmonary disease (COPD)- within 1-2 months.
Myth 2: Antimicrobials should be changed every 5-7 days to avoid pathogen resistance
The emergence and spread of resistance to antibiotics is a serious problem for effective antibiotic therapy. Evaluating the clinical efficacy of treatment should be carried out within 48-72 hours after the appointment of the preparation, and in case of clinical failure, the antibiotic should be substituted without the continuation for the first 5-7 days of therapy. If the drug is effective, then replacing it with a 5-7 day is not necessary, moreover in such a change or unfinished course increases the risk of development of antibiotic resistance in microorganisms. Surely, there are other indications for replacement of the agents even against the background of effective therapy, for example, in case of the development of severe adverse drug reactions requiring discontinuation of treatment, or high potential toxicity of the antibiotic, limiting the duration of its use, but these situations are rare in clinical practice and are the exceptions rather than rules.
Myth 3: Strong and weak antibiotics
Many doctors believe that using penicillin is a poor decision because it is no longer powerful agent, and for 60 years of its use all the microorganisms developed resistance. Undoubtedly, the problem of antibiotic resistance is very relevant to both developing and well-developed countries. At the same time, B-hemolytic streptococcus group A (BSAA) Streptococcus (S.) pyogenes - the causative agent of tonsillopharyngitis, scarlet fever, erysipelas, streptococcal impetigo is highly sensitive to B-lactams (penicillins and cephalosporins). These antibiotics are the only class of antimicrobials to which the S. pyogenes resistance did not appear. Proceeding from this, all treatment guidelines for acute streptococcal tonsillopharyngitis recommend penicillins (penicillin or amoxicillin) as the gold standard.
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