tl;dr - Asking your doctor for the shortest reasonable course is a good thing that will both protect you as a patient as well as minimize your risk of antimicrobial resistance. But the key phrase is ask your doctor, do not take it upon yourself to decide when to stop them. Take whatever course you’re prescribed.
Pharmacist and 4th year medical student with a passion for antimicrobial stewardship and infectious disease.
Historical treatment duration for most infections was truly quite arbitrary. Evidence for most infections, when it is actually tested, have pretty consistently demonstrated shorter treatment durations than were classically taught (10-14 days for pneumonia now generally 5-7, 14 days for Gram Negative Bacteremia now 7, etc). There is a subset of infectious disease doctors that are bucking the trend of historical “you have to complete your course advice” for some infections. In general, what I have seen is recommendations to discontinue antibiotics with significant clinical improvement AND a non-life-threatening infection in a non-sterile body cavity. So nobody is shortening course durations for empyemas or endocarditis.
The issue becomes expecting patients to know what constitutes clinically meaningful recovery and whether or not their infection is one of the “safe” ones to stop antibiotics earlier.
At the end of the day, I totally disagree with your premise, as we should always strive for the minimum safe antimicrobial exposure. However I do agree that telling patients “shorter is better” is bad advice because I don’t want laypeople making these decisions when usually no-ID physicians don’t make them.
flooppoolf@lemmy.world 10 months ago
NYT undoing years of “finish your fucking course”
godzillabacter@lemmy.world 10 months ago
Yup, it’s hard to have a good discussion about the changing tides in ID without feeling like you’re causing a bunch of backsliding and non-compliance. I think being honest with people that the data is generally poor about how we select durations is the moral thing to do. But I do want you to just take your damn antibiotics as prescribed instead of going rouge because you heard “shorter is better” and your pneumonia recurring.
MaximilianKohler@lemmy.world 10 months ago
WITH CITATIONS.
“finish your fucking course” is wrong, and pigheaded people like you that refuse to review scientific evidence and reshape your opinions accordingly do a lot of harm and make it impossible for the scientific method to work and for the scientific community to update the public when the evidence changes.
flooppoolf@lemmy.world 10 months ago
Look man, I gave the link a good and thorough read. Leave the hate at the door. I already said it’s good research, it’s just kind of all over the place.
What that link is saying is already in practice. If it’s a viral infection you won’t get antibiotics, if it’s a clean procedure you probably won’t get antibiotics for more than a day.
That’s already in practice. Because studies show antibiotics are probably not the most important in those select very few cases. Those are good practice methods and are part of IDSA guidelines.
What is not in practice, and what I feel is the main point of confusion here, is that everyone should take shorter courses.
Nope absolutely not. If your doctor says take it for x days then you do it because they already went through the protocol and have deemed X days to be the best course of action. Your doctors will let you know if you are a prime candidate for a shorter duration of therapy, they’ll do all the research for you because they will not risk your death by having your disease state possibly recur and in a more aggressive manner.
Telling everyone that everything should be shorter will only confuse patients. I promise that if you are a prime candidate for a shorter duration, your doctor will know, and will give you the appropriate course of treatment.
Another thing is this quote from the link you provided
“Antifungals also do collateral damage: Disruption of Intestinal Fungi Leads to Increased Severity of Inflammatory Disease …cornell.edu/…/disruption-of-intestinal-fungi-lea…. Immunological Consequences of Intestinal Fungal Dysbiosis (2016).
Long-term impact of oral vancomycin, ciprofloxacin and metronidazole on the gut microbiota in healthy humans (Nov 2018)”
It goes on to mention antifungals and then talks about different drugs not related to antifungals but that are instead used as additional therapy for when the exact cause is unknown. I was thinking it would mention AmphotericinB, Voriconazole, Itraconazole, Micafungin etc.
It just seems to be all over the place and is not a great source to base medical decisions off of. I’m sorry.
MaximilianKohler@lemmy.world 10 months ago
I’m not as confident as you are in the evidence-based nature/abilities of doctors. See …humanmicrobiome.info/…/doctors-are-not-systemati…